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LIBRARY OF CONGRESS. 



Chap. _______ Copyright No,.. 

ShelL____,____^ 



UNITED STATES OF AMERICA. 



Uhcov^ of 
©steopatb£ 



J 



By WILFRED L. RIGGS, D. 0., 

Dean and Professor of Physiology and Lecturer and Demon- 
strator on Theory of Osteopathy in Still College of Osteopathy. 
Member of the Examining and Operating Staff of the S. S. Still 
Infirmary. Demonstrator in Clinics of Still College of Oste- 
opathy. Member American Association for the Advancement 
of Osteopathy. Formerly Professor of Science Idaho State 
Normal, Etc. 




2>e6 fl&otneSt Howa 

IWew Science publishing Co, 

1900 



TWocoP JESRECE1VEOt 

Uurary of G 0ngret% 
Office of t|,g 

MAY 7 - 1980 

K«gltt«r ef Capyrlght* 
SECOND COPY, a , /Cfrdt, 

.30; /fff-v 









KEN VON PRiNTING A MPS. ( 
DE6 MOINBS.IOWA. 



Tty£0r£ 0f ®%itxupxttyQ 



.61475 to 

Those who would find in the natural arrangement 
of the various parts of the human body 

the source of perfect order, harmony and health 
this volume is respectfully dedicated by 

THE AUTHOR 



1900 

COPYRIGHT APPLIED FOR BY 

RIGGS AND HELM 



CONTENTS. 



PAGE. 

Health and Disease 15 

Principles of Osteopathy 41 

Sympathetic Nervous System 61 

Vaso-Motors 85 

Osteopathic Centers 95 

Theory of the Treatment of the Spine . . 107 

Regions of the Head and Thorax 119 

Regions of the Abdomen and Pelvis . . . .147 

The IyiMBs 164 

Gynecology and Obstetrics 179 

Constipation, Rheumatism and Catarrh . .193 

How and When 207 

Index General 212 



PREFACE. 



IN THE preparation of this volume the author has 
freely drawn from the rich store of anatomical 
and physiological facts which are a part of general 
science. For this he makes no attempt to give credit 
save in a general way. 

He has read the following works — On anatomy : 
Allen, Gray, Gerrish, Morris and Quain. On physi- 
ology : The American Text Book, Dalton, Flint, 
Foster, Stewart and I^andois & Stirling. On Osteop- 
athy he has read with profit the works of the distin- 
guished founder, Dr. A. T. Still, Dr. Chas. Hazzard, 
Dr. C. P. McConnell, Dr. A. P. Davis and Dr. Henry. 
Miscellaneous : Ranney's Applied Anatomy of the 
Nervous System, Ranney's Diseases of the Nervous 
System, Hilton's Rest and Pain, Holden's landmarks, 
Robinson's Abdominal Brain. On examination and 
diagnosis : Page, Vierordt, Corwin, Hare, and Cohen 
and E)shner. Osier's Practice of Medicine, Hughes' 



Practice of Medicine, American Text Books of Medi- 
cine, Surgery, Obstetrics, Gynecology. On Massage 
the author has read with pleasure and profit the works 
of Taylor and Dowse. 

To the many Osteopaths with whom he has been 
associated the author would say, " I am a part of all 
that I have met, ' ' and whatever of merit may be found 
within this volume is, in a measure, due to those with 
whom he has so fortunately come in contact. 

The author is deeply indebted to Dr. J. W. Hofsess 
and to Captain D wight H. Kelton, for many valuable 
criticisms and corrections while the work was passing 
through the press. 



INTRODUCTION. 



(\F MAKING many books there is no end " was 
^-^ a truth three thousand years ago : it is 
eminently true at the present time. There is nothing 
which so interests the human race as does an advance 
in the method of restoring to health a diseased body. 
That the administration of drugs has been empirical 
and that the knowledge of their effects has been 
bought at a great price is well known, but tradition 
still fetters the progress of the healing art. 

Aught which differs from the fixed order of belief 
as recognized by the profession, is condemned in 
advance and must run the gauntlet of criticism and 
opposition. To elucidate a method of healing which 
is based upon known facts of science is certainly 
a gratifying task. There is no fact of anatomy which 
may not be of value to the osteopathic physician. He 
uses all anatomical connections and relations. He 
must be a bloodless surgeon, whose scalpel never 
punctures the skin, nor sections the nerve, nor severs 
the tendon. His knowledge of anatomy must be 



10 
minute and profound, to the end that he may diagnose 
diseased conditions though far removed from the 
functional lesion. 

' ( Despise not the day of little things " is a text 
which the osteopathic practitioner should embody into 
his code of morals for daily repetition. The minute 
nerve twig extending from spine to distant organ or 
viscus, unimportant in size, is pregnant with sugges- 
tions of the cause of the disturbed function. But, 
while a knowledge of anatomy is essential to the 
thoroughly equipped practitioner, he must likewise be 
master of the known facts of physiology ; it is not 
enough that the osteopathic physician be able to fore- 
tell from the location of the lesion the viscus which is 
affected ; he must be able to predicate the nature of 
the disturbed function and' its general result upon the 
health of the patient. 

There can be no pathological changes in a tissue 
or organ which are not accompanied by disturb- 
ances in the metabolism of the part, and metabolism is 
wholly dependent upon the conditions of nutrition 
and nerve supply. 

Osteopathy is a protest against the growing practice 
of taking drugs. It offers a more rational means and 
bases its promises of cure upon the fact that in a 
healthy organism in perfect repair there is no pain, no 



11 

weakness, no disorder, and no disease. The laws of 
nature are immutable. Water flows in sparkling 
streams from mountain springs to the distant ocean in 
obedience to these laws. The woody fibres of the 
massive tree have been raised high in the air obedient 
to these same forces. 

The science of Osteopathy has magnified the impor- 
tance of the spine as a guide in diagnosis, basing such 
diagnosis upon the well-known physiological law of 
transferred sensation, and the anatomical connection 
between spine and viscus. From this fact comes our 
accuracy in diagnosis, an accuracy which is based 
upon mathematical calculation and cannot fail. The 
variations which occur in the relations and struc- 
ture of different parts of the organism sometimes 
produce embarrassing results to the surgeon and fatal 
ones to the patient. These variations are rarely suffi- 
cient to embarrass the osteopath, though he must ever 
be ready to correct errors in diagnosis due to varia- 
tions in position of lesion, by examination of the 
viscus affected. 

Every method of examination known to the medical 
world must be utilized to correct and to prove the 
accuracy of the strictly osteopathic diagnosis. 

The term lesion is used in osteopathy in a free 
sense as a cause of disease, but it is not restricted in 



12 
its meaning to osseous dislocations. That there are 
spinal lesions associated with the great majority of 
diseases is a fact to which every osteopathist can cer- 
tify. In many cases these are the causes of the 
diseased conditions ; in many others they are the 
direct results, yet, as sequelae, serving to prolong the 
disease. 

The science of Osteopathy is progressive. It makes 
a distinct advance in the art of healing. It demands 
no external aid but recognizes in man the power to 
successfully militate against the adverse conditions in 
which he is placed. There is no hypnotic so con- 
ducive to restful sleep as an equalized nerve force, no 
stimulant so effective as a perfect circulation, no reac- 
tion so natural as that rest which follows physiological 
action. The blood is the life. The nerve controls the 
condition and distribution of the blood. The science 
rests upon the truth that pure blood and normal nerve 
supply give health. The arrangement of the other 
tissues of the body are for and to this end. 

This science marks a new departure in three things 
pertaining to diseased conditions, viz.: etiology, diag- 
nosis and treatment. 

There is no authority in etiology save auatomj^ and 
physiology. The symptoms elicited and observed are 
but the logical results of some interference with 






13 

physiological function. Most of the facts upon which 
Osteopathy rests are the common possession of the 
medical world ; but the classification of these facts have 
given shape and system to the science. The resistant 
and recuperative powers of the body are being demon- 
strated. Order, perfect order, in the human frame 
results in a perfect performance of all the duties of 
that organism. The curve of the muscle, the glow of 
the skin, the gleam of the eye, all betoken a perfect 
adaptability, an undisturbed motion of fluids, a condi- 
tion called health. 

The science of Osteopathy is an exact one. The 
symptoms point the lesion ; the location and kind of 
lesion suggest the treatment ; its correction results in 
a restoration to health. 

The osteopathic physician finds no force outside the 
body which will maintain health or life. He trusts to 
liberating and equalizing the forces of the organism 
through the movements of the fluids. Motion is 
essential that the matter of the body may manifest 
itself ; and this manifestation is life. 

External forces produce a powerful and continuous 
effect upon the central nervous system. These influ- 
ences reach the center through the various afferent 
pathways, either consciously or unconsciously contrib- 
uting to life. The function of the air, the sunlight, 



14 
temperature, meteorological conditions ; these and 
many other forces contribute to one general state of 
health. It is upon this view that we seek to restore 
health by changing the nature, quality and amount of 
these forces. 

Passive movement has certain curative value. 
Motion may have been diminished ; this decrease of 
motion may lead to a loss of afferent impulses from the 
surrounding parts and thus to a diminution of physio- 
logical processes. The science of Osteopathy is 
entitled to separate, careful, special investigation, 
whereby its facts and principles may be recognized at 
their true therapeutic value. 

This method has the broadest affiliations with gen- 
eral science, resting upon all known truths of physi- 
ology, and in harmony with each. 



CHAPTER I. 



M 



HEALTH AND DISEASE. 
ENS SANA IN CORPORE SANO " is an Be za«onb e - 

tween mind 

old L,atin aphorism of which Rousseau, and body. 



the great French savant and philosopher, remarked 
that it is a short but complete description of a per- 
fect state in this world. These conditions assumed, 
all other earthly conditions are attainable. All things 
are possible to the fearless, perfect soul ; and fearless- 
ness comes only as an attribute of a perfect mental and 
physical condition. The body and mind are intro- 
active. The mind rules the body, yet the body in 
turn reacts most profoundly upon the mind. Bodily 
health, perfect bodily condition, insures mental health. 
Health is the end of all therapeutics. It represents 
the natural condition. It is not an end of life but a 
means to perfect living. Health may be defined as 
that condition of the organism which pertains when 
every organ is perfectly adapted to perform the func- 
tion for which it was designed. Nor is this condition 



16 



Health is a 
birthright. 



The health of 
the coming 
ages. 



of health unattainable — in fact, it is or should be the 
heritage of everyone — a universal birthright. To 
this end every child that is born has a right to demand 
that it come of healthy parentage — that weakness and 
pallor and disease should not propagate their kind, 
that health may be a universal possession of the domi- 
nant races. When that time has come then will the 
profession of physician become a thing of the past, 
since the knowledge which he possesses as expert, or 
professional attainments, will then have become general 
knowledge — a part of the common possessions of 
mankind. Then children will remain unborn from 
diseased parentage ; then those who are born will 
develop to that growth and strength which is their 
right, as does the twig grow into the tree or the young 
of the untamed animals reach their maturity, un- 
hampered by pain, untouched by disease. There will 
come a race with nerves unracked by pain, which have 
never yielded to the seductive effects of the deadly 
anodynes. Then strength will be the glory of 
man and woman, and weakness and sickness a 
disgrace. That day will see men whose biceps meas- 
ure will exceed that of the neck ; and wasp-waisted 
women will be a tale that is told — a tradition of the 
barbarous past. This condition is typified in IyOng- 
fellow's "Village Blacksmith"— 



17 

"The smith, a mighty man is he, 
With large and sinewy hands, 
And the muscles of his brawny arms 
Are strong as iron bands." 

To maintain this state and to restore it if lost, carelessness 

causes disease. 

has been the object of all systems of therapeutics. 
Carelessness, a trait of the race, has caused man to 
disregard prophylaxis and to trust more and more to 
what are considered as curative agents. So long 
as there is no noticeable deviation from the usual con- 
dition of ease, comfort and strength, just so long will 
the body receive no thought. Health is modest, 
retiring. Subjectively it is unobtrusive and calls for 
no thought. Objectively it is prominent and com- 
mands attention. ' Tis the condition which excites 
the admiration of all ; the envy of those who have 
been so unfortunate as to lose it, for health is a jewel 
unesteemed till lost, but once lost not all the wealth of 
Golconda can replace it. Longfellow says, ' ' Life 
without health is a burden ; with health is a joy and 
gladness." Empedocles delivered the people of 
Selinus from a plague by draining a marsh and was 
deified and a coin was struck in his honor. But 
simple as may seem this condition, there is necessary 
a great amount of care in order that the organism may 
be maintained in proper working order. It may seem 
strange to say that health is so difficult to maintain, 



18 
but when we think of the manifold intricacies of the 
structure of our bodies, the wonder rather seems that 
we are able to maintain so nearly a perfect condition 
of the body as exists in the majority of persons. There 

J. tic whtcv&C" 

variousorgans. is such an interdependence between the various organs 
each of which contributes to the welfare of the other 
that the disarrangement of a single one will lead to the 
disarrangement of the whole. There exists the vari- 
ous systems, nervous, circulatory, respiratory, muscu- 
lar, osseous, etc., so perfectly related that the one 
cannot be at all disturbed in form or in function 
without profoundly affecting each of the others. These 
systems interact normally so as to produce the physio- 
logical functions of all ; if a disturbance either prima- 
rily or secondarily reaches the nervous system and 
through it various other subordinate systems, soon 
harmony, order and health have disappeared-. 

Diet must play an important part in the health of 

Vitality main- 
tained by diet, each community and each individual. The vitality, 

the resistance of the body can be maintained only by 
a dietary affording the proper amount of each of the 
three great classes of alimentary principles, — carbo- 
hydrates, proteids and fats. But even here the per- 
sonal desires and idiosyncrasies of the patient must 
largely determine the particular form under which 
each class shall be taken. To be productive of the 



19 
highest good, the food should be palatable. Enjoy- 
ment and appetite are the best digestives. 

All hygienic knowledge should be rigorously applied Details of 

° ° ° rr hygiene im- 

in the treatment of disease. Sunshine, pure air, venti- pm an ' 
lation, exercise and diet all are essential in prophy- 
laxis and in the cure. In maintaining his own health 
or in advising others to the same end, the osteopath 
should never forget these minor details which are 
known, and have been proven in many instances to be 
life saving. " Prove all things ; hold fast that which 
is good." Exercise, outdoor air, light, well venti- 
lated living and sleeping rooms and one-third of each 
twenty-four hours given to sleep will surely contribute 
to health, mentality and virtue. 

Disease is the reversed condition. It represents a Life compared 

to a whirlpool. 

change in the normal metabolic processes. Health is 
maintained by a proper and perfect metabolism. Into 
the ceaseless vortex certain substances are continually 
entering, losing their identity and momentarily con- 
tributing to the whirlpool, lending energy to draw in 
other particles. By this intussusception, life is mani- 
fested, certain low grade products of oxidation are 
formed, energy is freed. This regular interchange from 
the organic, through the living maelstrom to the lower 
organic and to the inorganic, constitutes health. Within 
certain limits the rate of change and the products may 



20 
vary without seriously disturbing the functioning of 
feSrdedme- the organs, but should the rate of change be markedly 

tdbolism pro- 
duce disease, interrupted, then may biproducts be formed which 

the depurative organs are not able to withdraw, sub- 
oxides are formed and these acting as toxins interfere 
with the harmony of the organism, producing disease. 
Disease (from dis — not ; and ease — a state of rest) is 
defined as that state or condition of the body which is 
marked by an inharmonious action of one or more of 
its organs, due either to abnormal conditions or 
structural change. The causes of these conditions are 
usually considered as exciting or the immediately con- 
ditioning factor, and predisposing or that which tends 
to the development of the condition. These two may 
be further subdivided and may be so interrelated that a 
strict differentiation is not always possible. They act 
together in a majority of cases confusing etiology of 
diseases and puzzling the diagnostician. True, in 
many cases there is a causa causans, or the causing 
cause, which is the essential predetermining factor. 
This is in many cases so evident that the secondary 
causes are apt to be overlooked. In addition to the 
foregoing causes of disease there are the ordinary 
causes, such as change in temperature, seasonal and 
climatic variation, altitude, etc., to which all persons 
are more or less exposed and against which the 



Causes of 
disease. 



21 

resisting power of the individual is ordinarily sufficient 
protection . 

Classifying causes of diseases as internal and 
external, we have the following : 

Causes acting from within : 

i. Heredity — Parents to off- 
spring, transmitting either dis- 
ease or a tendency to disease. 
I. Predisposing ( 

]2. Individual peculiarities not 

inherited — connate and ac- 
quired. 

II. Mental and emotional causes. 

III. Structural lesions — secondary to or resulting 

from any of the above. 

IV. Abnormal blood supply. 
V. Altered nerve influence. 

Causes from without •' 
I. Physical or mechanical, producing structural 
or relational lesions. 
II. Chemical — substances coming in contact with 
the organism producing abnormal metab- 
olism. 
III. Micro-organisms. 

Many times is disease produced by conditions Condition8 
which are known to be dangerous but which cannot ™ntra£d. 
be avoided. Man constantly chooses occupations 



22 
which are productive of disease or resides in a locality 
known to be prejudicial to health. We feel that there 
are other occupations in which health would be ours 
in greater measure, but fitness, desire, etc., impel us 
to an occupation in which we draw heavily and con- 
tinually upon our vital capital. Health is a means 
to an end, and in insuring it, by residence, occu- 
pation, care of the body, etc., there is a limit to the 
amount of premium that one can pay. Even life itself 
may be too dearly bought and death with duty is to 
be preferred to life with dishonor, cowardice and 
shame. The question comes to all, what can I afford 
to pay for health ? Bach must answer for himself. 
The teacher in the schoolroom follows day after day 
an occupation that she knows is taking her life and 
strength. The shop girl hour after hour and month 
after month works for a miserable pittance and stands 
at her counter because she knows that every occupa- 
tion in life is crowded and she holds with the tenacity 
of hopelessness and fear to the only means of subsist- 
ence which she possesses. 

But to discuss the causes of disease. Of the 
predisposing causes of disease, the most important are 
those connected with some peculiarities of the bodily 
structure which may be (i) inherited, or (2) congenital 
but not inherited, or (3) acquired after birth. 



23 

In the so-called hereditary diseases it is not the QerrM not 

usually trans- 

disease itself nor its direct specific cause which is muted in 

K heredit(tr\i 

transmitted from parent to child, but some peculiarity 
of structure of tissue or organ which in the course of 
development makes the person peculiarly susceptible 
to disease or to causes which produce the disease. 
These may be, either forces acting from without, or 
else the peculiarity produces disorder itself either by 
excess or defect of structure or function. Very few 
diseases may be transmitted directly in utero, but of 
this number are syphilis, small-pox and a few others. 
The belief that the specific germ of tuberculosis and 
scrofula is never transmitted but that inheritance gives a 
peculiar susceptibility to the disease owing to weak- 
ened resistance on the part of the protoplasm, is now 
prevalent though not proven. 

Heredity plays a part in immunity just as it does in immunity by 

heredity. 

liability to disease. This is seen not only in the 
family but on a broad scale among races. Perhaps 
this even may be due to their obedience to or neglect 
of certain laws of health. But certain it is that the 
negro of the southern states is almost immune against 
cancer and in his African home is free from syphilis, 
though in America is peculiarly subject to this disease. 
He is peculiarly liable to tuberculosis and immune to 
malaria. 



24 



Lesions, 
primary and 
secondary, 
causes of 



The term lesion as used in this work includes 
any deviation from the normal either in structure, 
relation or function. It may be either a causa 
causans, or it may act as an exciting cause of disease 
either with predisposing causes or with other causes 
from without. In other words, lesions, as the term is 
used by osteopaths, may be either primary or secondary. 
The division is self explanatory. The term primary 
lesion is ordinarily restricted to conditions which pro- 
duce disease ; hence, causative. The term secondary 
lesion is applied to such as are the result of diseased 
conditions. These lesions are sequelae of previous 
diseases, yet may be causes of present pathological 
conditions. The osteopath seeks for his lesions along 
the spine and considers them either in the light of 
causes of disease or of evidences of a diseased 
conditions of the organ. 

These lesions along the spine may vary in kind and 
in degree. The effect is not infrequently dispropor- 
tionate to the amount of the lesion, sometimes the 
least detectable variation from the normal may produce 
the most pronounced and widespread effects. On the 
other hand the spine is sometimes so distorted that 
one would expect a marked interruption to all the 
processes of life, yet no such disturbance results. 



25 

These spinal lesions may be of any of the following 
types or more likely a combination of some two of 
them : 

1. Osseous. — This maybe so pronounced as to be how osseous 

lesions produce 

a dislocation, or so slight as to be called a subluxation disease. 

In either case there may be an interruption to the 
free passage of nervous impulses which stream con- 
tinually from viscus to center over the afferent nerve 
fibres entering the cerebro-spinal system, or from 
center to viscus over the efferent nerve fibres which 
also pass through the spinal and cranial foramina. 
These nerves serve as channels for all communication 
between viscera and center ; these bind the parts 
together into a harmonious whole ; these establish 
equipoise and health. Every viscus, muscle and 
tissue of the body is governed by impulses from the 
centers passing through these foramina or through 
corresponding openings in the base of the cranium. 
Likewise through these go all those impulses which 
reach the centers from the sensorium. Sensations of 
ease, muscular sense, pressure, temperature, blood 
pressure, vaso-motor condition, touch, all pass through 
these channels. How rational that any change in 
these co-apting surfaces should disturb the equilibrium 
between the incoming and the outgoing impulses ; this 
disturbance leads to a failure of some one or more 



26 
of the viscera to function normally, disease being the 
osseous lesions, necessary result. Osseous lesions are usually primary 

primary and j sr j 

causes of disease and diseased conditions, though 
muscular contractions in convulsions, in rheumatism, 
and in other diseases may produce actual dislocation of 
many of the strongest articulations of the body; so, 
too, these and other causes may lead to slight subluxa- 
tion of rib or vertebra which in turn may affect some 
organ. This effect may be deferred or immediate. 
This serves to explain many of the sequelae of diseases 
which otherwise are inexplicable. 
Muscular 2. Muscular. — Aside from osseous lesions the 

lesions effect 

nerves reflexly. . . , - . . . ., 

next most productive of disease is muscular. 
This is usually a result of some abnormal condition, 
some irritation to its motor nerve, resulting in its con- 
traction, hyperemia, and hyperesthesia. This condi- 
tion acting reflexly may irritate the nerves to the 
viscera, there affecting sensory and vaso-motor 
conditions. Thus the muscular contraction, itself a 
result, may serve as a cause for the continued disturbed 
condition in acute diseases; its removal is followed 
by an amelioration of the conditions. These muscular 
lesions may result from strains, overwork, exposure to 
cold, drafts, etc. 

3. Ligamentous. — The third kind may be classed 
as lesions of connective tissue, or ligamentous. The 



27 

muscular lesion always exists with the osseous at the Inereme of 

connective 

beginning. It may exist independent of it but in tissue inter- 

71/ljLt7 %/ LtiO'¥L 

either case a continual contraction of a muscle means 
a hyperaemia, venous stasis and retrograde metab- 
olism, namely, — an increase in the connective tissue 
wrappings of the muscle, tightening and thickening 
the ligaments and tendons and thus pressing upon the 
channels for blood, lymph and nerve impulse. This 
will explain why the osteopath attributes so many 
diseased conditions to lesions ; not lesions in the nar- 
row sense of dislocation, but in the sense of any 
abnormality of structure. Their correction leads in 
most cases to a cure ; in all cases the immediate result 
is to palliate the condition. The correction of Correction of 

lesions 

these lesions is the removal of the cause in many woducecur: 
diseased conditions. In bacterial diseases even 
this treatment produces effects which tend to cure by 
sending more and purer blood to the organ, increasing 
the activity of assimilative and depurative tissues, 
increasing the vitality and strength of the patient. 

It seems to be an established belief, at best it is a 
prevalent one, that in all things the medical man and 
the osteopath must be on opposing sides of every 
question ; and should the opposition by priority have 
occupied the only tenable position it is necessary that 
the osteopath should occupy any position, however 



28 



No conflict 
between 
Osteopathy 
and the 
germ theory. 



untenable, rather than stand in the same position as 
his medical friends. This need not be. The belief in 
the existence of lesions as a cause of disease has led to 
a very conservative estimate among osteopaths as to the 
functions of bacteria found in the body. The discrep- 
ancy between the explanation of the causes of disease 
from the view-point of the bacteriologist and that of 
the osteopath is apparent only, for there is no neces- 
sary conflict. The osteopath acknowledges that 
inorganic and non-living poisons introduced into the 
system may cause disease and death, and why not 
acknowledge, too, that organisms whose rate of 
increase is almost unbelievable and the virulence of 
whose products is scarcely equaled by that of common 
poisons may not produce like effects ? No one, for a 
moment, claims that carbolic acid or some of the 
compounds of lead may not be the real cause of 
diseased conditions if introduced into the body, — 
though no one forgets that the resisting power of 
some individuals is greater than that of others. 

The history of the growth of the idea that micro- 
organisms are the cause of many of the diseases that 
flesh is heir to, is an interesting one. It entails the 
idea of spontaneous generation. The discussions 
which led to the positions occupied by scientists began 
before the Christian era. All the ancients believed in 



29 
spontaneous generation. Dead bodies decaying 
became bees, hornets, flies, worms and beetles. 
Animals were held to develop from moisture. Aris- 
totle asserts that sometimes animals are found in 
putrefying soil, in plants and in the fluids of other 
animals. He announces that every substance which 
has become moist and every moist body that has 
become dry, produces living creatures, provided it is 
fit to nourish them. Two thousand years later this 
same belief prevailed, extending downward through 
the middle ages, and incidentally contributing to the 
science of bacteriology. 

In 1668 Francesco Redi, expressed a belief, seem- 
ingly the first to do so, that maggots formed in 
decaying meats did not arise de novo, but were a 
progeny of the flies which swarmed upon it. His 
proof of his position is historic. Covering jars con- 
taining the meat with paper, and later with gauze, he 
showed that the flies deposited their eggs on the 
covering, while the meat decayed as usual. 

It was at this time that I,euwenhock (1675) per- 
fected the compound microscope to such a degree as to 
make it of some service. By the power of the lens 
life was revealed which before had been but dimly 
guessed at. The doctrine of spontaneous generation 
again fought for recognition, while Plengig of Vienna 



30 



Plengig first 
suggested 
germ theory. 



Tyndall's 
experiment. 



for the first time, in 1762, announced a connection 
between the organic life revealed by the microscope and 
the origin of disease. This idea was for a long time 
neglected, but other experiments were carried on which 
led to the present position of scientists. The doctrine 
of spontaneous generation was finally overturned by a 
series of brilliant experiments, beginning with Spal- 
lanzani. who subjected sealed flasks with infusorial 
fluids to the temperature of boiling water and got no 
evidence of life ; Schultze, who heated flasks and 
passed air through sulphuric acid into them daily with 
no evidence of life, made a vast step forward in 1836 ; 
while Schwann proved that calcined air admitted to 
putrescible liquids did not produce life. Pasteur 
demonstrated that meat did not decay if kept free 
from germs. 

The crucial test for spontaneous generation 
was made by John Tyndall. He arranged an air- 
tight box with glass ends in such a manner that 
test tubes introduced into the bottom could be filled 
without communication from the outside. Waiting 
until a ray of light passed through the box from end 
to end made no illumination, indicating that all the 
dust of the air had settled to the bottom or had 
adhered to the sides which were oiled ; the test 
tubes were then filled with such mixtures as had 



31 
under ordinary circumstances been known to soon 
become swarming with bacteria of putrefaction. The 
mixtures were then heated to the boiling point and 
allowed to stand for a few days, when they were 
heated again. By this method of repeatedly raising 
to a high temperature and allowing it to cool to a 
temperature at which development of bacteria would 
take place he hoped to thus overcome the condition 
which he had conceived to be the cause of the failure 
of other experiments of a similar nature. 

His idea was that the spores have a greater resist- 
ance to the action of heat than the fully developed 
germs, and that they had withstood the tests of other 

Life doe 

investigators, but by successive heatings he hoped to aenovo. 
destroy them in their developing or in their matured 
state. The plan proved successful and it was demon- 
strated most conclusively that life does not originate 
de novo. The tubes stood for months with no evidence 
of life or decomposition. This experiment proved, 
with others of a similar nature, that decomposition 
does not take place except it be associated with the 
action of certain microscopic organisms. 

Tyndall's remarkable experiment finally overthrew 
the doctrine of spontaneous generation. The neces- 
sary data were now established for carrying out the 



32 

crucial tests to which the germ theory was subjected 
before it was accepted. 

These tests put in common language were as fol- 
lows : 

The disease must be one that can be clearly iden- 
tified. The specific germ must in all cases be capable 
Kooh'stest. of being isolated. It must be present in the diseased 
tissue or organ and not merely in the fluids associated 
with the organ. It must be capable of being reared in 
pure cultures and lastly when germs from these pure 
cultures are introduced into the system of an otherwise 
healthy animal, the introduction must be followed by 
a disease having the same symptoms as the original 
disease. The test made in numbers of cases has 
established the germ theory as a scientific fact. It 
places the germs as a cause of disease this far, that, 
without the introduction of the germs the disease 
would not have occurred. The osteopath regards the 
germ as an exciting cause of disease. He considers 
the resisting power of the body an important factor 
in prophylaxis. This power depends upon the con- 
dition of the blood ; and it is thus through the blood 
that the osteopath seeks to militate against develop- 
ment and effects of the pathogenic germs. The 
Red Mood as a osteopath practices asepsis and antisepsis. He con- 

germicide. 

tends that the best germicide is good red blood, and 



33 

acknowledges that drugging is theoretically the 
method of killing the germ. The only difficulty 
comes in finding a drug that will reach the bacterium. 
Unfortunately, when drugs are administered, the 
patient yields to the effect of the poison before the 
germ is killed. 

There is no longer any discussion among intelligent 
men as to whether certain forms of germs are danger- 
ous and destructive to life ; but how to prevent their 
entrance and to combat their ravages when once 
entered are the great questions for the physician. 

A bacterium may be defined as a minute vegetable Definition of 

° bacteria. 

cell. Its component substance is called myco-protein. 
Its chemical nature has never been absolutely deter- 
mined. For convenience of study those which produce 
diseased conditions are divided into three classes. 

First. The cocci, which are spherical in form, 
either existing as single spores, micro-cocci ; or united 
in pairs, diplo-cocci ; or arranged in chains, strepto- 
cocci ; or in clusters or groups, when they are called 
staphylo-cocci. 

Second. The bacillus whose form is more or less rod 
shaped. 

Third. The spirilum having a cork-screw or spiral 
form. 



34 

Experiments have shown these to be present in pro- 
fusion in most places, yet they do not occur in the 
atmosphere over the ocean very far from land, at the 
tops of mountains nor normally in the tissues of the 
body. They follow the law of the universe in that 
each produces its kind , although under certain condi- 
tions it seems that their products may vary. 

The term bacteria is used to include only vegetable 
organisms. Micro-organisms may mean either vege- 
table or animal organisms, though but few of the 
protozoa are pathogenic. 

Of the multitude of bacteria there are perhaps 
less than twenty that are deleterious to the system 
while there are numbers and numbers absolutely nec- 
essary to life. 

As to their size they are about 25>000 of an inch in 
diameter. Their process of development is rapid as is 
their rate of multiplication. Cohn calculated that 
the weight of a single germ is 10 ,ooo,ooo,ooo ° f a milli- 
gram, yet under ideal conditions they multiply so 
rapidly that in three days a single germ may have 
reached the astounding mass of 7,500 tons, its progeny 
numbering 5,000,000,0*00, 000. So marked is their 
absence from the normal tissues of the body that their 
presence there is always taken as a certain evidence of 
disease. That under certain conditions they enter the 



35 

tissues of the body and exist within them is not 
denied by any one. 

The marvelous rapidity of development prepares one 
for the exceeding virulence of many diseases consequent 
upon the activity of germs. Their products are 
leucomanes, ptomains and toxalbumins which destroy 
the integrity of the tissues, overthrow the harmonious 
rule of the nervous centers and produce death as the 
necessary result of such inharmony. Bacteria are 
variously described according to conditions of growth, 
as serobiotie, those growing in the presence of oxygen ; 
and anaerobiotics, those which do not grow in the pres- 
ence of oxygen, while the term optional or facultative 
aerobiotic is applied to those which may thrive under 
either condition. It is worth more than passing notice 
that the presence of sunlight is deadly to most forms 
of germs, a fact of fundamental importance in sanita- 
tion. 

According to their products bacteria are divided into 
several classes of which the pathogenic or disease 
producing kind alone interest us in a work of this pathogenic 

germs. 

nature. These germs may be developed locally and 
by their very presence block the channels of the fluids 
to or from the part, or they may by their chemotactic 
power effect the same result. 



36 

Germs of suppuration are both toxic and chemotac- 
tic and by the effects of their toxins upon the cells 
with which they come in contact these in turn are 
destroyed and may be rendered chemotactic. Septic 
germs are those which multiply in the liquids and 
are thus distributed to all parts of the body. 

That germs cause small-pox, scarlet fever, measles 
and other contagious and infectious diseases no sensible 
person will for a moment deny. The proofs are on 
every hand sufficient to satisfy the inquiring observer. 
But not so with the exacting scientist. In order that 
a disease can be attributed to a specific germ it must 
comply in every particular with Koch's tests mentioned 
above, — postulates first demanded by Henle but impos- 
sible with the methods in vogue in his day. 

But the practical question comes to us, " How does 
the osteopath treat germ diseases ? ' ' I,et me answer 
by another. How does medicine treat such cases? 
In diphtheria, in pneumonia and in pulmonary 
tuberculosis it would seem that vapors or topical 
application would prevent the ravages of the germ, 
but they are little used. In typhoid fever, in which dis- 
ease the germ is demonstrated to be in the alimentary 
tract, drugs should be able to reach and destroy all 
such offending organisms, but even the advocates of 
medicine do not advise the use of drugs in this disease. 



37 

In no germ disease is there a safe and certain specific. 
The object of all treatment is to increase the resisting 
powers of the individual until there has been estab- 
lished within the body the germicidal powers of certain 
cells or germicidal serum, the product of these cells. 
When this condition is secured then the germs cease 
to multiply, the toxins are eliminated, the thermogenic 
centers are no longer excited, metabolism is reduced 
in rate, the thermolytic centers function properly, 
the fever falls and the patient begins to recover. 
Drugs now are given to stimulate the circulatory 
and other vital organs, The disease is self lim- 
ited. By the very product of the germ activity 
its further development is limited. The osteopath in 
his treatment seeks to reduce and control the fever, 
thus preventing excessive metabolism. He allays osteopathy in 

r ° J germ diseases. 

nervousness and thus maintains equilibrium between 
the nervous system and the subordinate tissues. But 
above all he removes obstruction to the circulation in 
the affected organ and sends to it the best blood in the 
body. He increases oxidation and enriches the plasma 
and nourishes the germicidal cells. He controls ther- 
mogenesis and thermolysis. He also may, in a 
crisis, stimulate a heart as no medicinal stimulant 
can do. Foster, the great physiologist, says that 
electrodes and induction coils are rough means and 



38 

that we may more nearly approach the normal phases 
of nerve action by mechanical stimulation, citing 
as an instance the reflex inhibition of the heart 
by vagal impulses, the result of irritating the abdomi- 
nal splanchnics. 

Thus in treatment of acute diseases, experience 
has shown that by a knowledge of the physiolog- 
ical functions of the various organs, and a knowledge 
of the manipulations necessary to arouse the latent 
powers of the body, the osteopath may very favor- 
ably affect all diseases usually considered as being 
of bacterial origin. That he accomplishes this is 
shown by the records of his treatments in pneumonia, 
typhoid fever, measles, diphtheria, etc. The treat- 
ments result in establishing an immunity against 
the further ravages of the germ. 

This condition may be defined as the condition of 
an animal by which it resists the entrance of the 
disease producing germs or their growth and patho- 
genesis. It is both racial and individual. There are 
races which are immune to or susceptible to certain 
diseases. The negro is practically immune to yellow 
fever ; he is especially susceptible to tuberculosis. 
The Jew is free from many diseases, but is especially 
susceptible to diabetes. 



39 

Man, then, has a condition of immunity, a condition 
of the body which resists disease. Circumstances may 
vary this power. . 

The virulent germ anthrax very few animals resist, 
but some do ; nor can this resistance be explained on 
structural difference. Immunity may be destroyed by 

m Susceptibility. 

a changed condition of the blood. Thus, exhaustion 
may make a person susceptible that would otherwise 
have been immune. The membranes of the nose are 
supposed, in health, to be germicidal. Susceptibility 
may be defined as that condition which favors the 
entrance, growth and development of pathogenic germs 
within the tissues. 

There are various modes for the entrance of the 
germs of disease. 

They may have an entrance through the skin or 
mucous membrane ; 

By the respiratory tract, through its mucous mem- 

Mode of 

brane, which is different from the ordinary mucous entrance of 

J germs. 

membrane ; 

Through the digestive tract ; 

Through wounds ; 

Through the placenta into the placental circulation. 

From these sources they get into the blood stream. 
They may also have a passive entrance, that is, they 
may develop and grow outside and enter through the 



40 
walls of the vessels. They may be carried directly 
by the leucocytes or indirectly by way of the lymph 
stream or lymphatics into the venous channels. 

Prevention of germ disease can be best secured by 
isolation. For those who must necessarily be exposed 
to the action of the germs there is nothing which will 
so protect against their entrance and action as perfect 
bodily condition, good action of the heart, thorough 
respiratory powers, good digestion and an observance 

of the rules of hygiene. 

» 

Disinfection must always be thorough. It should 
be the last action of the physician at the termination 
of an infectious case to cause a thorough disinfection 
of the room, furniture, bedding, etc., exposed to the 
germs. Of his own person he cannot be too careful. 
Antisepsis and asepsis are the safe-guards of every 
person who has charge of the health of others in time 
of sickness. 



CHAPTER II 



PRINCIPLES OF OSTEOPATHY. 

IN ALIy organic life the cell is histologically and 
physiologically the unit. The conditions which 
are essential to its growth and development vary. In 

Cell essential to 

the undifferentiated state, that is, before the histologi- development. 
cal differentiation of the cells into the various tissues, 
the only thing necessary to the development of the 
cell is that the nourishment be continuous and the 
temperature, of course, be such as to permit of the 
normal actions of the cell. Instances of this kind are 
seen in the unicellular animals, and in the leucocytes 
and similar cells in man. In the more highly differ- 
entiated tissues the activity of the cell is dependent on 
another condition, that of nervous control. The nerves 
as higher tissues, through their impulses, act as con- 
trolling influences. The normal performances of cell 
function are irritability, contraction, assimilation, 
growth, reproduction and excretion. These functions 
summed, modified and correlated constitute the 



42 

phenomenon of life. Since health is a condition in 
which every organ and part adequately performs its 
function, then it must follow that the health of the 
organ is dependent upon the healthy condition of the 
cell, for the organs are composed of cells and their 
products. The cell is really the important part of 
every tissue and its health or disease depends upon the 
blood and nerve supply. 
Health main- First. This is a basic principle of Osteopathy, that 
ana nerve! ° ot through the blood supply and the nerve supply to the 
tissues, is the health of the body maintained. 

Secoyid. It is a law of physiology that any impair- 
ment in the structure or function of an organ causes 
evidence of a tenderness on pressure, and tenderness on pressure is 

lesion. 

the best evidence of a lesion of an organ, that is, a 
lesion in the sense in which we have defined it — any 
abnormal condition. It is not always possible to reach 
the organ directly, but it is possible in all cases to 
reach the efferent or afferent nerve fibres of the organ. 
These nerve fibres are sensitive to pressure just as are 
the nerve fibrils in the organ itself. 

Third. Tenderness along the course of the nerves 
of any organ is an evidence of a lesion of the organ. 
The lesion may be temporary or permanent. 

Foiirth. Pain is a warning of a pathological state 
of an organ or a tissue and may be referred to the 



43 
tissue or organ affected or to some other distribution 
of the nerve through its branches. Hence, pain as the 
sign of a lesion may refer to the organ affected or to 
the peripheral distribution of the nerve. There will 
be tenderness somewhere. Pain does not always warn 
you where the lesion is. Every practitioner is familiar 
with cases in which treatment has been directed to the 
knee when the trouble is in the hip. If you follow 
the pain back far enough you will find it is due to the 
condition somewhere of the nonperformance of func- 
tion of some organ, and nonperformance of function 
is a lesion in the sense in which we defined it. 

Fifth. Any irritation to an efferent nerve, either Effect of 

muscular 

central, peripheral or along its course disturbs the l6Slon ' 
vaso-motor and motor equilibrium between organ and 
nerve center and leads to a consequent contraction of 
the muscles innervated by the corresponding segment 
of the central nervous system. This contraction tends 
to increase the severity of the symptoms and to prolong 
the disturbed effect. This same result follows the 
primary lesion of a viscus, irritating its afferent nerves. 
Sixth. Any irritation to a nerve or interference 
with the passage of the physiological nerve impulses 
to an organ may produce a lesion of that organ. In 
any case there will result a disturbed vaso-motor 
equilibrium and an increased contraction and increased 



44 
irritation to the muscles supplied by the nerves from 
its segment. 

Seventh. In like manner a continual irritation may- 
lead to an increase of connective tissue, shortening 
and thickening the ligaments, interfering with circu- 
lation, nerves and tendons and so prolonging the 
disease and aggravating its symptoms. Thus, if the 
muscles are contracted at the fourth, fifth and sixth 
dorsal regions, it means there is a variation from 
the usual amount of blood sent to that region and this 
change in blood supply means an increase in growth 
of connective tissue. This increase in growth of con- 
nective tissue around the vertebrae will overcome the 
freedom of their motion and lead to irritation of and 
pressure upon the nerves passing from this region. 
This irritation is referred to the stomach and cannot 
be removed until you remove the cause. For this 
reason we invariably treat the spine to relieve this 
condition. Disease of the stomach may have caused a 
congestion of these muscles and their increase in size 
until they encroach upon the pathway of the nerve. 
We must first overcome the contraction, whether it be 
the cause or the product of the disease. Then we can 
restore the normal condition of the nerves and nature 
will do its work. 



45 

Eighth. Any obstruction to the free passage of the obstruction 

leads to disec 
efferent impulses to an organ may result in diminution 

or a cessation of the normal metabolism of the organ, 

either trophic or secretory, or both, thus directly 

leading to a diseased condition of the organ or 

producing a nidus for bacterial activity, or resulting in 

destructive metabolism and finally in all cases in 

disease. 

Ninth. The human body is a machine for the The body a 

machine. 

transformation of energy. The amount and quality 
of this energy formed in a large measure determines the 
individuality of the person. The proper distribution 
of this energy determines the health of the individual. 
Any interference in the production, manifestation, 
or distribution of energy will result in a changed 
metabolism — a condition called disease. This dis- 
eased condition may remain indefinitely so long as the 
condition which produced it remains, the disease then 
being called chronic. Now any restoration to health 
must be accomplished by changing the rate of manu- 
facture, the quality or the equalization of the bodily 
energy. This cannot be secured by adding foreign 
substances to the mechanism, but by the simple process 
of adjustment and correction. The friction removed, 
the delicate structures replaced in their proper posi- 
tions, the vital actions proceed uninterruptedly, ease 



46 
succeeds disease, strength follows weakness, pain 
disappears. There is no radical change from the 
usual conditions which give health. The organism 
demands nothing new. 

Tenth. Oxidation is the process by which bodily 
changes are produced — bodily temperature maintained . 
Motion increases oxidation and energy. Any influence 
which decreases energy retards metabolism and forms 
incomplete oxidation products. These suboxides are 
disease producing. Therefore any manipulation 
which tends to increase motion removes suboxides 
and compels a restoration to health. Motion is 
health. 

Eleventh. The skin is largely a nervous organ. 

Skin a nervous 

organism. This in health receives the normal physiological 
impulses which pour into the central nervous system, 
there producing changes and arousing afferent impulses. 
These afferent impulses maintain the tonic conditions of 
glandular and other tissues of the body. Any increase 
or decrease of these impulses may lead to a disturbance 
of any of the outgoing impulses, either increasing or 
diminishing them. Thus the skin may, by artificial 
stimulation and a hyperaesthetic condition, depurate 
the nerve centers, causing exhaustion. On the other 
hand in conditions of anaemia and anaesthesia stimula- 
tion of the sensory nerves in the skin may arouse 



47 
afferent impulses to the proper physiological degree 
which will restore the lost vigor and tone. 

Twelfth. Passive muscular movement necessarily- 
entailed upon osteopathic treatment serves in many 
cases to restore the equipoise between nerve centers 
and the muscles by distributing the energy. This 
means health. The condition in many cases of 
disease is that of disturbed equipoise between muscle 
and nerve centers. Passive muscular exercise serves 
to divert the energy from the nerve centers to its 
proper distribution, the muscles, thus re- establishing 
the proper equipoise which is health producing. 

Thirteenth, When several muscles are supplied by 
branches of the same nerve their function is to act in 
harmony and in unison ; this fact is of value in 
diagnosis of lesion in case of loss of muscular power. 
The reader is able to supply numerous examples of 
such arrangement. 

Fourteenth. "Superficial pains on both sides of the 

body, which are symmetrical, imply an origin or J^erfi/iai 

pain. 

cause, the seat of which is central or bilateral ; while 
unilateral pain implies a seat of origin which is one- 
sided, and, as a rule, exists on the same side of the 
body as the pain." Every pain has its distinct and 
separate signification. 



Hilton's law. 



48 

Fifteenth. "The same trunks of nerves, whose 
branches supply the groups of muscles moving a joint, 
furnish also a distribution of nerves to the skin over 
the insertions of the same muscles ; and the interior 
of the joint moved by these muscles receives a nerve 
supply from the same source." 

Sixteenth. i ' Every fascia of the body has a muscle 
or muscles attached to it, and every fascia must be 
considered as one of the points of insertion of the 
muscles connected to it." 

Seventeenth. Steady pressure upon the terminal 
filaments of a nerve or upon the course of the nerve 
will prevent the passage of impulses along the nerve, 
thus inhibiting its action. Motion, sensation, reflexes, 
vaso-motor effects are all alike affected ; hence 
increased activity of any organ is reduced to the 
normal by pressure on the nerves of the organ. The 
inhibitory nerves are of course an exception to this 
rule. Pressure upon these would produce no effect or 
else increase the activity of the organ ; the effect 
being dependent upon whether the nerves were in 
action at the time. 

Eighteenth. Activity of an organ may be aroused 
by stimulating the functional nerves to the organ. 
Marked variations in pressure upon any portion of a 
nerve will stimulate the nerve. Thus the osteopath 



49 

treats a nerve to arouse its activity by successive 
variations in pressure rapidly applied. 

Nineteenth. The points along the nerves where 
stimulation will be most effective are (i) at the 
periphery of the nerve, (2) at the emergence of the 
nerve from the spinal canal. Inhibition is likewise 
most easily accomplished at these points. 

Twentieth. A stimulation of the vaso-constrictor 

..' Vaso-motor 

nerves of an ors^an will dimmish the amount of blood effect on 

capillaries. 

pressure in the capillaries ; their inhibition will pro- 
duce the opposite result. The latter is the condition 
in inflammation and oedema — the former overcomes 
these conditions. 

Twenty-first. Head has found that ' ' When a painful 
stimulus is applied to a part of low se?isibility in close 
central connection with a part of much greater sensibility, 
the pain produced is felt in the part of higher sensibility 
rather than in the part of lower sensibility to which the 
stimulus was applied." 

Tactile sensations sometime act in the same way — 
a transference called allochiria. This law of trans- 
ference of effects of nervous stimulation may be 
carried further and applied to motion, as in cases from 
a reflex affecting the opposite member ; to vaso-motor 
changes and to all forms of nerve impulses. Nor is 
this all. Just as sensory, motor and vaso-motor 



50 

impulses may be transferred, so, too, may inhibition 
act reflexly. The skin and muscle of a spinal segment 
are supplied by afferent nerves from the same central 
origin, a region which also gives origin to efferent 
nerves going to some one or more of the viscera. By 
pressure on these sensory fibres we check the deluge 
of impulses into the center and thereby decrease 
the chemical changes within the center itself. It is 
upon these chemical changes that the nature, quality 
and quantity of the outgoing impulses depend. To 
reduce these to the normal will serve to restore the 
organ to harmonious relations. This is a fact of 
fundamental importance in our treatment. Our 
practice shows beyond possibility of error that inhibi- 
tion of the periphery of one branch of a sensory nerve 
will reduce the expression of pain in other branches 
of the nerve. 

Head's law is a statement of the fact upon which 
we base many of our diagnoses by spinal examination. 
The various deductions from it are applied in treat- 
ment of nearly all pathological conditions. 
„■■** Twenty-second. The only natural and rational 

Cure depends -* J 

°cau»e mo%l ° method of treating such conditions is by removal of 
the cause, and this result (except in cases demanding 
surgical interference) is perfectly secured only by such 
manipulation as will overcome all interference to the 



i 



51 

free passage of the efferent and afferent impulses 
between organ and center ; and by stimulation or 
inhibition counteract the present condition of innerva- 
tion or irritation, thus allowing the inherent recupera- 
tive power of the body to restore to normal structure 
and function the deranged organ. 

Osteopathy is a therapeutic science grounded upon 
the known and verifiable laws of physiology just 
enumerated. From those principles we deduct our 

definition of the science. Osteopathy is a method of osteopathy 

defined. 

treating disease by manipulation , the purpose and result 
of which is to restore the normal condition of nerve 
control and blood supply to every organ of the body by 
removing physical obstruction, or by stimulating or 
inhibiting functional activity as the condition may 
require. 

By the term physical obstruction we mean any direct 
interference to the nutritive or functional fluids or 
forces of the organ, as pressure upon a vessel or nerve 
by an abnormal condition of some denser tissue of 
the body. This will cut off the nerve force and 
affects the blood supply. Either of these may result 
in producing an abnormal function of some organ 
or organs and thus lead to a diseased condition. 

Osteopathy achieves its chief results through the 
nervous system. Nerve action may be influenced : 



52 

First. Through the centers directly. We may effect 
a certain nervous control of the abdominal organs by 
pressing directly, as near as possible, over the solar 
plexus. Pressure there may act to inhibit the 
impulses sent out from that center which are pro- 
ducing pain in the various abdominal organs. 

Second. We may influence nerve action through the 
fibres. We do this in various ways. We may affect 
the fibres by removing any obstruction to the nerve 
impulses along the fibre, or we may affect the fibre by 
stimulation, not by removing the cover, but through 
the medium of the covering structures, putting alter- 
nate pressure upon it in such a way as to stimulate it. 

Stimulation is a broad term and may be defined as 

stimulation the act of producing or increasing functional activity. 

defined. 

The methods of accomplishing this are varied ; physi- 
ological or natural, mechanical, thermal, electrical 
and chemical. Of these the first or physiological is 
the result of the interaction of the organs and the 
reaction of the nervous system to the stimuli of the 
environments. In conditions of health this kind is 
sufficient ; in response to it the heart keeps up its 
rhythmic throbbing, the glands act, the various 
organs perform their functions. Each increased 
strain, within limits, produces more activity. The 
skeletal muscles are in a partial state of contraction 



53 

called skeletal tone in response to a continual rain of 
impulses through the organs of touch, temperature, 
sight, smell, the muscular sense. While this is true 
for the skeletal muscles it is eminently the case in 
the condition known as arterial tone. Upon those 
impulses from without depend the healthful state of the 
circulatory system. These stimulations are continuous 
and conducive to perfect action. The air stimulates 
the skin, it reacts upon the wall of the alveoli, the 
blood causes the centers of the organs to keep up 
their constant outgoing impulses. The second and 
most nearly natural in its effects is the mechanical, 
the mode which the osteopath uses to the exclusion of 
the others for the purpose of assisting nature. 

Mechanical stimulation in its effects is similar to 
physiological. There are two ways by which the 
osteopath, through pressure, affects nerve fibres. One 
is by variation in the degree of pressure, producing 
stimulation. The other by continued steady pressure 
cutting off the passage of impulses along the nerve, 
thus producing inhibition. Experience shows that 
steady pressure upon a nerve will produce no pain or 
impulse, even though carried to the extent of crushing 
the fibre of the nerve. We will now define inhibition 
as an act which restrains or retards functional activity. 
Inhibition of an organ may be produced by preventing 



54 

inhibition. the passage of impulses to it, or it may be pro- 
duced (as is the case of inhibitory fibres to the heart 
which pass through the vagus nerve) , by impulses to 
the organ whose effect is to restrain the action of the 
organ. The osteopath must understand this double 
meaning of the term for he frequently uses both 
methods of producing inhibition. 

This question now presents itself to us : In what 
way may we repress or excite action ? Nervous 
tissue controls the other tissues. It is by nervous con- 
nection that the organs of the body perform their 
normal function. 

Excitation of an organ may be perfectly and posi- 
tively secured only by removal of obstructions to the 
free passage of efferent and afferent nerve impulses to 
the organ. It is clear that continued steady pressure 
upon a nerve prevents the passage of impulses through 
the nerve. This would produce a cessation of the 
normal flow of these impulses to the organ, as is 
illustrated by constant pressure on the nerves to the 

Pressure may stomach. But it might have two effects. If it were 

have two 

perfectly constant the pressure would have the effect 
of restricting the normal impulses from the cerebro- 
spinal center, resulting in diminution of functional 
activity. There would result enervation or loss of 
tone of the organ, tone to which it is entitled. Vary- 



55 
ing pressure will increase these impulses, thereby 
increasing the tone and activity of the organ. 

Tone is that healthy, normal state intermediate 
between complete relaxation and contraction, pro- 
duced by a summation of impulses from the external 
world sent along the pathway of the nerve to the 
central nervous system ; and there, by a reflex 
mechanism sent out to the muscles which are con- 
trolled by the same segment of the cord. Thus we 
have arterial tone as a result of reflex mechanism in 
continual action. It is a state of partial contraction 
characteristic of muscles which enter into the struc- 
ture of the blood vessels. By tone or tones of glands 
or centers we mean their physiological state of activity. 

These facts will serve to illustrate how obstruction 
to nerve impulses may interfere with the normal func- 
tion of the organ by lessening the activities, thus 
serving as an inhibition. 

Physical obstruction or interruption may interfere 
with functional activity by increasing it. If steady 
pressure in any way becomes a varying pressure, how- 
ever slight, that would result in a constant irritation 
to the nerves, producing impulses exciting the organ 
to unusual activity and finally to a pathological condi- 
tion. So, too, by interference with the nutrition of a 
region the irritability of its nerves would be affected 



56 
and a changed metabolism result. Again, we may- 
remove obstruction which serves as an inhibition, 
resulting in a stimulation. Nerve activity is basic 
to the activities of the other organs of the body. 
Nerve action may be influenced by action upon the 

Nerve activity 

basic. centers themselves. A physiological or true center 

means a group or collection of nerve cells connected 
with some specific organ or function by means of 
afferent and efferent fibres. 

Osteopathic centers are entirely different. An oste- 

osteopatuc opathic center is a practical one. By the term we do 

center defined. 

not necessarily mean a local group of cells controlling 
function, but a point at which we may most advantage- 
ously reach the nerves or cells controlling the organ. 
To illustrate : The center for coughing is near the 
third dorsal vertebra ; there is not at that point in the 
spinal cord a group of cells whose function it is to 
produce coughing. We mean that there are entering 
that region afferent nerve fibres whose impulses have 
been transmitted, resulting in a muscular contraction, 
giving rise to a cough. By removing the irritation 
thus preventing the impulses coming from that peri- 
phery to the center, we have treated the center. 

At the points of emergence of spinal nerves we are 
able to obtain more satisfactory results than at any 
other. Because we get certain results by treating cer- 



57 
tain spinal nerves we cannot assert there is a true 
physiological center at that level in the cord. Centers 
may be anywhere so far as treatment is concerned 
between emergence and peripheral ending of a nerve. 
This will explain why we speak of centers osteopath- 
ically which have no physiological existence. 

We stimulate centers by treating their afferent and how treated. 
efferent nerve fibres. Our effects are from stimulation 
or inhibition along the pathway of the nerve. We 
may further stimulate the action of the center by 
stimulating the peripheral distribution of the sensory 
nerve. We will go farther : We are able to treat 
directly the muscular tissue and produce contraction, 
or inhibition of muscular contraction. In this we 
draw our conclusions from a limited number of cases. 
In cases of perfect anaesthesia contracted muscles will, 
under osteopathic treatment, relax as perfectly as 
though the sensory nerve fibres were functioning. 
Whether it is the result of direct stimulation of 
the muscle is a question we cannot answer with 
certainty, though the indications are to that effect. 
In a case that came under my observation the 
anaesthesia was so complete that even pressure 
upon the deeper muscles produced no sensation. I 
argue from that case that a muscular tissue will relax 



58 
on treatment when not connected with the sensory 
fibres as readily as when it is. 

The point is this : It is not necessary in order to 
produce an effect upon a muscle, particularly if that 
effect be relaxation, to stimulate the endings of the 
sensory nerves in the skin. The greater part of our 
work of relaxation is accomplished on the more deeply 
lying muscles. Painful stimulation of the sensory 

Painful treat- . . 

ment useless. nerve of the skiu produces a defensive contraction of 
the muscle underneath, therefore, the best results are 
obtained with the minimum amount of pain. To this 
end it is necessary to place the hands gently on the 
integument above the muscle which you desire to 
relax, care being taken to use the flat portion of the 
fingers. Now by approximating the fingers of the two 
hands you will produce a fold of skin between them. 
Now strong pressure will produce practically no sensa- 
tion of pain in the cutaneous nerves. If this pressure 
be accompanied by a separation of the hands the effect 
of relaxation will be produced on the contracted mus- 
cles felt beneath. 

I will here emphasize the caution just expressed, 
that you, as far as possible, eliminate the use of the 
ends of the fingers in treatment. Since it often happens 
that your first treatments are directed towards over- 
coming headaches and therefore administered near the 



59 
base of the skull, congestion or chronic contraction 
sometimes follow from the application of too much force 
to a limited space beneath the ends of the fingers. 
There are few regions, if any, which yield so readily to 
osteopathic manipulation as the neck. There is no 
part of the body more susceptible to injury if treatment 
be incautiously applied. 

We are able to inhibit contraction of a muscle by 
osteopathic treatment applied directly to the muscle 
itself. It is a physiological fact, that direct application 
of stimulation to a muscle itself will produce contrac- 
tion. From experience we say we can overcome a 
contracted condition of a muscle, though the sensory . 
nerves are not in any way affecting it ; e. g. , in case 
of perfect anaesthesia. 

Dr. Schreiber sums up the effects of mechano- Effects of 

mechano- 

therapy as follows : therapy ' 

First. To cause an increased flow of blood to mus- 
cles and soft parts, increasing thereby the circulation, 
and removing accumulations of waste tissues whose 
retention causes various disturbances of function. 

To strengthen muscle fibres, and by setting up 
molecular vibrations to induce changes, not only on 
the muscle and nerve fibres, but perhaps even in the 
nerve centers themselves. 



60 

Second. To cause the resorption of exudations, 
transudations, and infiltrations, in such organs as are 
accessible. To effect the separation of adhesions in 
tendon sheaths and in joints, without recourse to the 
knife. To remove, by grinding away, intra-arthritic 
vegetations. 

Third. To increase by passive and active exercise 
of all the muscles, the oxidizing powers of the blood, 
in this way correcting disturbances in its composition 
and stimulating all the vegetative processes. 

Fourth. To relieve the congestion of such internal 
organs as the brain, lungs, intestines, uterus, kidneys, 
etc., by increasing the flow of blood to the muscles. 

Fifth. To stimulate directly the sympathetic nerv- 
ous system, thus increasing secretion and reflexly the 
activity of unstriped muscle fibre, and so relieving 
various functional derangements. 



CHAPTER III 



SYMPATHETIC NERVOUS SYSTEM. 

THE UNITY apparent in the structure of the 
nervous system is evidenced in a physiolog- 
ical unity, harmony and interdependence which proves 
the truth of the statement that an isolated portion of 
the nervous mechanism does not exist in a perfect 
individual. Aside from the central nervous system 
there is what is known as the sympathetic system. 
This term includes the following distribution : To 
the internal viscera ; to the glands outside as well 
as within the hemal cavity ; to the vessels as vaso- 
motors, and to the hairs as pilo-motors. Their com- 
plete distribution is to the viscera, vessels and to 
the plain muscle fibres generally. But this distribu- 
tion to the plain muscular tissue is not confined 
exclusively to the sympathetic system, the vagus hav- 
ing extensive visceral distribution. In addition to 
this, many fibres from spinal nerves have visceral con- 



Structure. 



62 
nection, either passing through the sympathetic gan- 
glia unchanged or not entering it. 

The sympathetic system consists of a collection of 
ganglia, nerve trunks and plexuses. The ganglia 
contain cells, and fibres both gray and white, the 
latter in all cases connected with cells within the 
cerebro- spinal system. The plexus is essentially a 
network of fibres, though it may also contain cells. 
The gray fibres are truly sympathetic, having their 
trophic connection with the cells in the sympathetic 
system. 

With these extensive ramifications it is necessary 
that there be a varied and complicated mechanism ; 
hence we find : 

First. The two great gangliated cords extending 
from the ganglion of Ribes above, connecting the 
carotid plexuses via the anterior communicating 
artery, downward to the coccyx where the two sacral 
chains are united by a ganglion (the coccygeal, or 
the ganglion inifiars), situated on the anterior sur- 
face of the coccyx. 

Second. The great prevertebral plexuses. 

Third. The fibres and plexuses of distribution. 
[There are also connected with the cranial nerves ; 
ganglia which in structure and connections agree with 
the sympathetic and may be considered as a part of 



White rami 
communl- 



63 
this system.] The first of these groups, the great 
gangliated cord, consists of ganglia connected by- 
short cords, the ganglia being named cervical, dorsal, 
lumbar, sacral, etc., approximately corresponding to 
the vertebrae, except in the cervical region, where 
the segmental arrangement has been modified by a 
segregation of seven into three, called superior, mid- 
dle and inferior cervical. 

The foundation of the sympathetic system is consti- 
tuted by small, white fibres from the cerebro-spinal ^S 
system through certain nerves into the cords and gan- 
glia of the sympathetic. These constitute the white 
rami communicantes, which connects the cerebro-spinal 
and sympathetic portions of the nervous systems. 

They come, in man, from the first thoracic to the 
second lumbar, inclusive, being both afferent and 
efferent in function. In the sacral region the homo- 
logues of the white rami pass directly to the preverte- 
bral plexuses and are thence distributed to the pelvic 
viscera as splanchnic divisions of the sacral nerves. 
There are no white rami in the cervical region. The 
visceral branches of the third nerve (to ciliary gan- 
glion via short root), of the seventh, ninth, tenth and 
eleventh, correspond in function to the white rami. 

White rami enter the sympathetic either at the 
lateral ganglia or at the cords connecting them, and 



64 
may come from both roots of the spinal nerves. 
Those of the posterior root are from the spinal gan- 
glia and are afferent fibres. Those from the anterior 
are efferent. These white fibres end in any of the 
following ways : 

First. Iyosing their sheaths in the lateral ganglia, 
they end in dendritic brushes within the lateral ganglia. 

Second. Some pass unchanged through the lateral 
ganglia to the prevertebral plexuses (white rami effer- 
entes), or they may continue as spinal fibres to their 
distribution. 

Third. The fibres of the white rami ending in the 
lateral ganglia may branch before entering, giving off 
one, two or three collaterals, thus connecting with 
several ganglia. 

Fourth. The fibre may not end in its correspond- 
ing ganglion, but may pass to ganglia at either higher 
or lower levels. 
Functions. The functions of the white rami are varied. They 

transmit all the impulses from the cerebro-spinal sys- 
tem to the sympathetic ganglia and plexuses and vice 
versa. This work is done by those which end within 
these structures. These are : 

First. Vaso-constrictors, from anterior roots, end- 
ing in lateral ganglia. 



65 

Second. Cardiac augmentors, ending in middle and 
inferior cervical ganglia and in first thoracic. 

Third. Viscero-motors from certain spinal nerves, 
also the corresponding fibres from the ninth, tenth and 
eleventh cranial nerves. 

Fourth. Pilo-motor fibres, also motor nerves to 
sphincter of iris through third nerve. 

Fifth. Secretory fibres to the sweat glands and to 
the glands of the various viscera. 

Sixth. Viscero - inhibitory fibres also end in this 
way, though in some cases they pass directly to the 
viscera. 

Seventh. Afferent fibres from viscera to cerebro- 
spinal center. 

In addition to these white fibres which transfer their 
impulses to the sympathetic and are succeeded by gray 
fibres, the vaso-dilator fibres pass unchanged to the 
viscera, though some seem to end in the solar plexus. „ 

' ° r Gray rami 

Gray rami communicantes connect the lateral cord with cantes and 

their distribu- 

all the spinal nerves. They are neuraxons of cells twn ' 
lying in the lateral ganglia, usually the one from 
which they make their exit to the spinal nerve, though 
rarely they pass upward or downward through the 
cord to the succeeding ganglion. They unite with the 
anterior primary division of the spinal nerves and 
have any one of the following distributions : 



66 

First. Peripherally to the distribution of the ante- 
rior division of the spinal nerves, — to their muscular 
and cutaneous distribution. 

Second. They may follow the anterior division 
centrally to the main nerve trunk, whence they follow 
the posterior primary division to its distribution. 

Third. Centrally to the recurrent branch of the 
spinal nerve and with it to the wrappings of the cord 
and to the structure of the cord itself. 

Fourth. Back through the wrappings of the pos- 
terior root, to the dura of the cord. 

The first and second vaso-constrictors are distributed 
to the vessels of the skeletal muscles and of the skin, 
secretory to the sweat glands, and pilo-motors to mus- 
cles of the hairs. 

The third and fourth are vaso-motor to the cord — 
mainly vaso-constrictors. 

In addition to the rami communicantes there are true 
sympathetic fibres, originating in the lateral ganglia, 
which pass forward to the prevertebral plexuses. 
With these are medullated fibres which have passed 
through the lateral ganglia, together constituting the 
rami efferentes — the gray, sympathetic ; the white, 
spinal. 

The function of the sympathetic system may be 
stated generally as follows : It presides over the move- 



67 
merit of the plain muscle tissue, nutrition partially, Functions of 

the sympa- 

secretion usually, general sensibility of the viscera, thetic - 
thermotaxis and vaso-motor conditions. When dis- 
turbed reflexly it affects one viscus from another and 
may act almost independently of the cerebro-spinal 
system under unusual conditions. 

Specifically the functions of the sympathetic may be 
classed as follows : 

i. Independent, actions which continue when all 
connection with the central nervous system has been 
destroyed as in the (a) ganglia of the heart, (5) the 
mesenteric plexuses, (V) the plexuses of the uterus, 
Fallopian tubes and ureters. 

Even these are modified either in the direction of 
stimulation or inhibition by impulses from the cerebro- 
spinal system. 

2. Dependent, — 

(a) Afferent impulses. 

(b) Secretory action and trophic. 
(V) Vaso-motor. 

The superior cervical ganglion is situated on the superior 

cervical gang- 

rectus capitis anticus major muscle internal to the Connections. 
tenth nerve and behind the internal carotid artery at 
the level of the second and third vertebra. It is con- 
nected with the first four spinal nerves, and with the 
ninth, tenth and twelfth cranial nerves. This ganglion 



68 
is almost an inch in length and a fourth as wide, and 
is of great importance to the osteopath, as through it 
he controls the vaso-motors to the head and face. It 
is continuous above with the carotid and cavernous 
plexuses and through this with the arteries and vessels 
of the brain. Below it is connected with the middle 
cervical ganglion which lies opposite the sixth or 
seventh cervical vertebra, almost at the level of the 
inferior thyroid artery. Above, this ganglion is con- 
nected with the cavernous and carotid plexuses and 
through these gives communication to the sixth nerve 
within the cavernous sinus, and with the Gasserian 
ganglion as the internal carotid artery passes through 
the apex of the petrous portion of the temporal bone. 
The cavernous plexus sends filaments into the third 
Relation to and the fourth nerves, thus completing the control of the 

the eye. 

blood supply to the eye and its motor apparatus. This 
fact is of prime importance in eye trouble. Osteopathic 
experience proves that trouble with the eye is asso- 
ciated with a lesion in the upper cervical region, located 
in the vast majority of cases, at the second and third 
vertebrae. 

The reasoning is plain. Here is the pathway of 
those vaso-motor impulses to its nutrient vessels, and 
their interruption means trouble with the nutrition and 
action of the eye. 



69 

It is followed upward from the superior cervical to 
the cavernous plexus, and from it to the twig following 
the arteria centralis retinae to the vessels of the inner 
part of the globe of the eye. The same pathway- 
answers for those fibres which control the muscles of 
the orbit, differing only in their final distribution. 

This ganglion controls the lumen of the anterior 
pial vessels and is of value in draining the cranial 
cavity in frontal headache due to congestion and 
venous stasis. 

The large deep petrosal branch, the sympathetic Distribution 

from MeckeVt 

root of the Vidian nerve, is from the carotid plexus and o an o lwn ' 
through this channel it supplies sympathetic fibres to 
Meckel's ganglion and through it to its distribution to 
the orbit, the palate, the nose, the pharynx, the 
antra, ethmoidal sinuses, tonsils, uvula, etc. 

The cavernous plexus lies closely associated with 
the carotid plexus in the cavernous sinus and 
sends fibres to the third and fourth nerves, 
and also to the ophthalmic division of the fifth 
nerve and through it to the ciliary ganglion. 
The importance of this ganglion in eye trouble, 
epistaxis, cedema of glottis, pharyngitis, laryngitis, 
sore throat, diphtheria, croup, etc., is readily seen. 
By stimulating the ganglion the blood vessels of these 
parts are constricted, capillary pressure is removed, 



70 

resorption takes place, and normal secretion and action 
is secured. Again this ganglion affords more direct 
connection with the pharynx than through the spheno- 
palatine ganglion, for it gives numerous fibres which 
following the blood vessels, are distributed with the 
ninth, tenth and eleventh nerves, forming the pharyn- 
geal plexus. Aside from this the superior cervical 
ganglion gives off a branch which is of much impor- 
tance in contributing to the great cardiac plexus. 

This ganglion controls the nutrition of the muscles 
of the face, the action of the mucous and salivary 
glands and even contributes to nourish the fifth nerve, 
the great sensory nerve of the head and face. This 
will make plain the value of this ganglion in diseases 
affecting the nerves and musles of the face, the mucous 
tract of the throat with its adenoid masses beneath. 
This ganglion contains a large number of cells which 
mark the beginnings of the fibres going to the distri- 
butions above mentioned. 

The middle cervical ganglion is situated anterior to 

Middle cervical ,, r ,, . ,; . ,, , f 

ganglion. the transverse process of the sixth or seventh cervical 

vertebra. It lies near the inferior thyroid artery and 
contributes fibres to it which control the lumen of its 
branches in the thyroid gland. It is associated in 
function with the superior cervical ganglion, transmit- 
ting the fibres from below which end in the superior 



71 
cervical ganglion. These fibres, as all the spinal fibres 
in the cervical sympathic, come from the dorsal spinal 
nerves; and, as white fibres, pass up to the ganglia in the 
cervical region. Ending in this middle cervical gang- 
lion are many cardiac augmentor fibres which have 
made their exit from the cerebro-spinal system at the 
second, third and fourth thoracic nerves. Beginning 
in this ganglion are the fibres which constitute the 
middle cervical sympathetic cardiac fibres, and which 
pass down into the thorax, helping to form the 
cardiac plexus. This middle ganglion then has three 
uses. In manipulation, steady pressure upon it will 
dilate the vessels of the head and face, will retard 
slightly the action of the heart, will dilate the vessels 
in the thyroid glands. Pressure alternately applied 
and removed will have the opposite effects. This 
nerve connects with two cervical nerves, the fifth and 
sixth, furnishing vaso-motor and perspiratory fibres 
to them. 

The inferior cervical ganglion is situated between 
the sides of the seventh cervical vertebra and the first In f erior 
rib and by its position is in connection above with the ganglion. 
middle and superior cervical ganglia and below with 
the gangliated cord. Ofttimes it is a mass united to 
the first thoracic and corresponds to the stellate gang- 
lion in the lower animals — either the first thoracic or 



72 
a union of several of the thoracic. It is situated over 
the first costo-central articulation between the vertebral 
and the subclavian arteries external to the vertebral 
and almost behind the inferior thyroid artery. It is 
connected to the middle ganglion by a cord, passing 
behind the subclavian artery. This cord is frequently 
double, passing both behind and in front of the artery. 
This anterior cord is called the ansa subclavian or 

Annulus of 

Vieussens. annulus of Vieussens. It sometimes extends from the 
cord below the middle cervical ganglion to the lower 
cervical or to the first thoracic. This annulus is much 
more frequent on the left side than on the right and by 
its contribution to the cardiac plexus exerts a powerful 
influence over the action of the heart. The branches 
of the inferior cervical ganglion are : i . To the two 
lower cervical nerves it gives vaso-motor fibres. 2. The 
inferior cardiac sympathetic to the cardiac plexus. 
3. It supplies fibres to the vertebral artery extending 
with it to the cranial cavity and controlling the blood 
vessels of the posterior fossa of the skull. It also 
sends fibres along the inferior thyroid artery into the 
thyroid gland, affecting both its vessels and its action. 
It controls the internal mammary artery and the comes 
nervi phrenici artery from this vessel. This ganglion 
is a strong point of attack in the treatment of the fol- 
lowing organs and diseases: (1) the thyroid gland 



73 

in goiter; (2) the circulation — sending augmentor 
impulses to the heart, if pressed upon sharply and 
alternately; (3) it has an effect on the phrenic nerves 
in many cases of asthma. 

The cervical sympathetic receives no fibres from the ^u?ca? n ° f 
cervical nerves but receives its spinal fibres from the 
dorsal nerves. It contains : 

(a) Vaso-constrictor for head from second, third 
and fourth dorsal. 

(b) Augmentor fibres to heart, chiefly from second, 
third and fourth dorsal. 

(V) Secretory fibres to salivary glands, upper 
dorsal. 

(d) Pupilo dilator and motor fibres to the involun- 
tary muscles of eye and orbit. 

(e) Afferent fibres whose stimulation causes activ- 
ity of the vaso- motor center in the medulla. 

The thoracic portion of the gangliated cord consists 

of two cords lying on either side of the vertebrse, 

within the hemal cavity and connecting above and tTwraciJ 18 

sympathetics. 
below with the cervical and the lumbar respectively. 

It consists of eleven, rarely twelve, ganglia with their 

connections, corresponding approximately with the 

costo-central articulations, though in the case of the 

upper one or two and the lower there is a slight failure 

to correspond to these positions. The branches of 



74 
distribution from the upper four or five are given 
chiefly to the corresponding vertebrae, their ligaments 
and to the descending portion of the thoracic aorta. 
From the second, third and fourth branches are sent 
to the posterior pulmonary plexuses which gives inner- 
vation to the vessels of the walls of the bronchial 
tubes and of the bronchioles within the substance of 
the lung itself. These fibres connect within these 
plexuses with the fibres from the pneumogastric, 
whence are furnished the motor impulses and sensory 
fibres to the walls of the air passages, the sympathetics 
affording the vaso-motor fibres. This distribution 
explains why the ' ' centre ' ' for the lungs is said to 
be in the upper dorsal region ; and also the philosophy 
of our treatment for such conditions as bronchial 
troubles, emphysema, pneumonia, tuberculosis of the 
lung and kindred affections. This, then, is what the 
osteopath calls the centre for the lungs located 
at the second, third and fourth dorsal. From the 
lower dorsal ganglia beginning at the fifth or sixth 
are given fibres to form three large nerves, the 
splanchnics, or the abdominal splanchnics of Gaskell, 
which are of wide distribution to the abdominal 
viscera, being transmitted in three separate and dis- 
tinct trunks, the great, the small and the smallest 
splanchnics. The great splanchnic takes origin from 



75 

the fifth to the tenth dorsal ganglion inclusive, and 
may be traced upward to the third or even the second 
thoracic ganglion, and passing downward through 
the crus is distributed to the semilunar ganglion and 
through it to the renal and suprarenal plexuses. 
Some of the fibres of this nerve are truly sympathetic 
fibres, while the majority are medullated fibres from 
the spinal cord. The small splanchnic comes from 
the ninth and tenth, or the tenth and eleventh and 
follows in the pathway of the great splanchnic and is 
distributed to the solar plexus and sometimes on the 
plexus to the kidney — the renal plexus. The small- 
est splanchnic comes from the eleventh ganglion, or 
from the region corresponding to the twelfth thoracic 
vertebra and its distribution is to the kidney. The 
term splanchnic should be used to include all nerves 
whose distribution is to the various viscera, but the 
more restricted use of the term has limited it to the 
nerves mentioned and we shall follow the general use 
of the term. 

A summary of the functions of the thoracic sympa- 
thetic is useful : 

i. Augmentor fibres to cardiac plexus from 
second, third and fourth. 

2. Vaso-constrictors to the lungs, second, third 
and fourth. 



76 

3. Certain afferent fibres whose stimulation results 
in cardio-inhibitory action in the medulla, sixth to 
tenth. 

4. The splanchnics contain vaso-constrictor fibres 
to abdominal vessels and other plexuses of the 
abdomen. 

5. The secretion of the intestinal glands. 

6. Secretory to sweat glands. 

7. Vaso-constrictor for arms, upper sixth dorsal ; 
for legs, lower dorsal and second lumbar. 

8. Viscero-inhibitory fibres to stomach and intes- 
tines. The motor fibres of the intestinal tract, except 
the rectum, are from the vagus. 

In the lumbar portion of the gangliated cord there 
are usually four small oval ganglia closely situated 
in front of the bodies of the lumbar vertebrae 
along the inner margin of the psoas muscle. On the 
right side the cord is under cover of the vena cava, on 
the left it is beneath the aorta. The branches con- 
necting the spinal nerves with the ganglia accompanjr 
the lumbar arteries and are covered by the fibrous 
bands from which the fasciculi of the psoas muscle 
originate. 

These ganglia, with their branches, connect with 
the plexus around the aorta ; some fibres reach 
the hypogastric plexus and through it the pelvic 



77 
plexus, others going to the ligaments and vertebrae 
within the lumbar region. Descending from the 
thoracic cord to the lumbar we find fibres having 
almost the same function as the thoracic sympathetic. 
In the lumbar sympathetic we find viscero-inhib- 

Lumbar 

itors to the descending colon and rectum, vaso-con- sympathetic-. 
strictor to the pelvic viscera, to lower abdominal 
vessels. These are from lower dorsal and first and 
second lumbar. From this source come the vaso- 
constrictors to legs ; vaso-constrictors to penis, first 
and second lumbar to hypogastric plexus, thence via 
pudic nerve as gray fibres. Motor fibres to bladder, 
upper lumbar. Motor fibres to uterus, first and 
second lumbar. Motor fibres to vas deferens (male), 
round ligament (female), first and second lumbar. 

The sacral sympathetic is diminished in size, consist- 
ing of a variable number of ganglia, usually four, 
joined below by a loop on which is the ganglion 
impars (the coccygeal ganglion). This portion of the 
sympathetic sends fibres to the pelvic plexus, others 
to the plexus on the sacral artery, to the ligaments, 
to the coccyx and to the coccygeal gland. There 
are no fibres passing into the lateral ganglia from the 
sacral nerves, these being supplied from the lumbar 
cord above. 



78 
Peculiarities The visceral branches of the sacral nerves are 

of sacral 

spianchnics. equivalent to white rami. They pass at once to the 
pelvic plexuses or to the pelvic viscera. 

Because of this direct relation between the visceral 
branches of the sacral nerves and the somatic divis- 
ions, the pelvic viscera respond very readily to sacral 
manipulations. In the sacral region we find : 

i. Motor fibres to rectum. 

2. Motor fibres to bladder. 

3. Vaso-dilators to penis — nervi erigentes. 

4. Secretory fibres to prostate gland. 

There are three prevertebral plexuses — the cardiac, 
solar and hypogastric, each of which has connections 
with and subdivisions in minor plexuses which are to 
be regarded as prolongations of the sympathetic along 
the blood vessels. 

The cardiac is a plexus deriving fibres directly from 

the vagi and the cardiac branches of each of the three 

Formation of cervical ganglia referred to above. It is divided into 

cardiac plexus. ° Q 

two portions ; superficial plexus just anterior to the 
aortic arch, and deep cardiac plexus situated behind 
the aorta anterior to the end of the trachea and 
above the bifurcation of the pulmonary artery. 

The superficial is derived from the superior cervical 
branch of the sympathetic and from the lower cervical 
cardiac branch of the pneumogastric on the left side. 



79 

The deep cardiac plexus is formed by all the cardiac 
branches from the cervical sympathetics, except the 
superior cervical cardiac on the left side and the infe- 
rior cardiac branch of the pneumogastric of the left 
side. From this plexus fibres extend along the pul- 
monary vessels to form the greater part of the anterior 
pulmonary plexus, being assisted in this work by a 
few fibres from the anterior pulmonary branches of 
the tenth nerve. The posterior pulmonary branches 
of the vagus unite with the fibres from the second, 
third arid fourth, sometimes also the first thoracic 
ganglia, and forms the posterior pulmonary plexus 
which is distributed to the substance of the lung, 
including the muscles to the air tubes and the vaso- 
motors to the various tissues of the organ. Here, too, 
fibres are given off which form plexuses on the coro- 
nary arteries of the heart. From this plexus we find 
fibres going to the heart and to the lungs, the great 
organs of circulation and respiration. The fibres are 
from the vagus, and through the cervical ganglia form cameo? 
the second, third, fourth, and, perhaps, first and fifth 
thoracic ganglia. It is for this reason that such a 
large part of osteopathic treatment is directed to these 
two regions, the cervical and the upper dorsal. 

The functions of the fibres in this plexus are : Aug- 
mentor fibres to the heart, vaso-constrictors to the 



80 
coronary arteries (through vagus), vaso-constrictors 
to the pulmonary and bronchial blood vessels, sensory 
fibres to the pleura and lungs, first to fifth dorsal ; 
sensory fibres to heart and pericardium, second to 
fifth dorsal. The sympathetic fibres may be reached 
at the middle or inferior cervical ganglion at which 
point steady pressure will retard the rate of heart- 
beat, and dilate the pulmonary arterioles. The same 
effect is produced by relaxing contracture in the 
interscapular region. By this treatment the heart is 
strengthened in two ways ; resistance in lung is re- 
moved, and rate of beat is retarded. 

Pain in pleura, pericardium, lungs or heart may be 
assuaged by pressure applied in the interscapular 
region — first to sixth dorsal. 

From the pneumogastric the cardiac plexus receives 
fibres to the heart, depressor, inhibitory, vaso-con- 
strictor, motor or constrictor fibres to the bronchioles, 
sensory fibres to the mucous lining of the air tubes. 

The solar plexus, which on account of its complex 
Solar plexus, connections and size, Byron Robinson calls the 
" abdominal brain," lies on the aorta just back of the 
stomach in the interval between the points of origin of 
the phrenic and renal arteries, practically surrounding 
the origin of the cceliac axis and the great mesenteric 
artery. From this great ganglionic mass there are 



81 
numerous branches given off accompanying the aorta 
and its divisions to all the abdominal viscera, forming 
secondary plexuses named after the arteries along 
which they pass : cceliac, superior mesenteric, supra- 
renal, renal, spermatic, aortic, etc. 

This plexus is formed of fibres from the great 
splanchnics, the lesser splanchnics and from the right 
pneumogastric. The least splanchnic enters chiefly into 
the formation of the renal plexus controlling the kid- 
ney. These fibres are from the fifth to ninth or tenth 
thoracic ganglia and are the vaso-motor fibres to the 
stomach, intestines and glands of the abdomen, 
viscero-inhibitory fibres to the stomach and intestines, 
and secretory to the glands connected with alimentary 
tract. In addition the splanchnics carry the impulses 
of general sensibility and pain. The vagus contributes 
to this plexus viscero-motor impulses which through 
it reach the stomach and intestine as far down as the 
sigmoid flexure ; sensory fibres from the mucous lin- 
ing are carried by the vagus. The vagus is the motor 
nerve to all portions of the stomach — fundus and 
pyloric portion including the sphincter pyloric. 

The solar or epigastric plexus continues downward „,..„. 

^ ° ^ Subsidiary 

as strands of fibres on either side of the aorta, cross fotyned S from 

solar. 

the common iliac arteries and form a plexus lying in 
front of the lowest lumbar vertebra. Into this plexus 



82 
enter the fibres from the adjacent lumbar ganglia form- 
ing the hypogastric plexus. From this are formed 
chiefly the various plexuses which are distributed to 
the pelvic organs. The pelvic plexuses lying by the 
side of the rectum serve as relays from the hypogastric 
and are increased by spinal branches from the third 
and fourth sacral nerves, rarely by the second. 

The fibres from this plexus differ in their distribu- 
tion with the sex, but we should ever remember that 
in the female we get the fibres through the lower lum- 
bar and sacral region to the vagina, uterus, ovary and 
tubes, and in man to the corresponding organs. 

Again from this source fibres are distributed to the 
bladder and rectum — facts of peculiar interest to us 
in the many cases of bladder trouble, constipation and 
piles. The fibres to the vagina and to the bladder are 
peculiarly rich in the continuation of the spinal 
branches from the sacral nerves. 

The functions of the hypogastric plexus briefly are 

i^'H')) cf'io'i) of 

hypogastric these : vaso-constrictor to pelvic viscera from aortic 

plexus and from upper lumbar ganglia ; viscero- 

inhibitor from lumbar to rectum ; viscero-motor. The 

hypogastric plexus contributes vaso-constrictor and 

viscero-inhibitor fibres. Through the hypogastric 

plexus pass sensory impulses from the pelvic viscera. 



ph 






83 

The sacral nerves furnish to the pelvic plexuses, 
motor nerves to hemorrhoidal plexuses of rectum, 
motor nerves to the vesical plexus controlling the 
walls of the bladder, sensory and motor fibres to 
bladder pass from second and third sacral, some sen- 
sory passing into hypogastric plexus and out to lumbar 
ganglia. The lower portion of the ureter is supplied 
by these nerves as well as the vas deferens and the 
vesiculse seminalis. The prostatic plexus receives its 
vaso-constrictor fibres from the first and second lumbar 
via the white rami to lumbar ganglia, thence to pelvic 
plexus. 

The vaso-dilator fibres to this plexus from the second 
and third sacral — the nervi erigentes. These nerves, 
the visceral or splanchnic branches of the sacral 
nerves, do not pass into the sympathetic ganglia, but 
pass to the plexuses and to the viscera direct. From 
the prostatic plexus they pass to the erectile sub- 
stance of the penis as the cavernous nerves, where 
they mingle with sensory fibres from the pudic. 

The vagina receives fibres from the second and third 
sacral, both motor and vaso-dilator. Stimulation of 
these serve as constrictors, of the vagina, and produces 
turgescence of the vulva. The uterus is supplied 
almost exclusively by fibres from the hypogastric 
plexus. From this source it receives vaso-constrictor 



84 
and viscero-dilator fibres. Constrictor fibres to the 
neck of the uterus pass to it from the first and second 
sacral. Its sensory fibres are through the hypogastric 
plexus and the lumbar nerves, chiefly the second and 
third. 



ACCOMPANYING DORSAL 

ROOT TO DURA ^DORSAL SPiNAl 
NERVE ROOT 




SOMATIC VASOMOTOR, 
PILOMOTOR, SECRETORV 



FROM RAMUS COMMUN. 
TO VERTEBRA AND 
INTERCOSTAL AND 
LUMBAR VESSELS. 



TO VERTE8R* LIGAMENTS, 
SPINAL VESSELS 4 OU.RA 



Ct,JcA T ° H| GhER GANGLIA 

SYMPATHETIC TRUNK 

RAM" EFFERENTES 



YJVIPATHETIC GANGLION 

GRAY VISCERAL FIBRES. 
MEDULlATEO FIBRES PASSING THROUGH "THE 
GANGLION TO PREVERTEBRAL PLEXUSES 
OR DIRECTLY TO VISCERA. 



SYMPATHETIC TRUNK 
FROM LOWER GANGLIA 



TO LOWER GANGLIA 



PLAN OF A LATERAL GANGLION OF THE SYMPATHETIC CORD 
AND ITS CONNECTIONS. 

Medullated fibres represented by continuous lines, non-medullated 
fibres by interrupted lines. 

—(From Gerrish's Anatomy .) 



CHAPTER IV. 



VASO-MOTORS. 

IN A WORK explaining the laws of physiology 
upon which the science of Osteopathy rests, the 
vaso-motor nerves contributing as they do a powerful 
influence to the circulation of the blood, are entitled 
to a full consideration. These fibres are, in their 
effect, of two kinds : vaso-constrietors or those whose 
activity decreases the lumen of the blood vessels, and 
vaso-dilators whose activity dilates the arterioles, 
increasing their lumen. 

This vaso-motor control is primarily a function of Thevnso _ 

. . . motor center. 

the cerebro-spinal system and is associated with certain 
cells situated in the medulla or bulb, a more or less 
diffuse center lying on either side of the median line. 
This bilateral center seems to be associated with the 
antero-lateral nucleus of Clark and it may be that 
these cells are the center for the vaso -motors. That 
there is a center for vaso-dilator impulses in the 



86 
medulla has never been proven, so we shall treat this 
center as if wholly vaso-constrictor in function. It is 
constantly in action producing tonic or hypertonic 
effects. The dilators act locally and irregularly 
producing hypotonic effects. In addition to the 
general vaso-constrictor center there are subsidiary 
centers located at varying levels of the spinal cord. 
These are true vaso-motor reflex centers. Again 
there are vaso-motor reflexes in the sympathetic 
centers. These centers control the rhythmic activity 
of many vessels of the body during health. 

The vaso-dilators are not proven to have any general 

vaso-auators. center, but are supposed to come from centers or cells 

located in different levels of the cerebro-spinal axis. 

The dilators then are only local in their action, the 

vaso-constrictors are both local and general. 

The dilators make their exit from any portion of the 
cerebro-spinal axis. The constrictors pass from but a 
limited portion* of it — that portion lying between the 
second dorsal and the second lumbar inclusive. 

All the vaso-dilators are medullated fibres until 
their distribution to the vessels. They may pass 
through the sympathetic ganglia, in which case they 
continue through it as white rami efferentes. They 
may, on the other hand, pass from the cord with the 
anterior nerve root or their homologues in the brain 



87 
and with it enter into the spinal nerves, following 
chiefly the motor fibres to be distributed to the blood- 
vessels of the muscle supplied by the nerve. 

The vaso-dilators are spinal nerves and lose their vaso- 

const)icto)\ 

sheaths only on the vessels whose walls they effect. 

The vaso-constrictors also begin as spinal nerves, 
connected directly or medially with the cells in the 
bulbar vaso-motor center, and they make their exit 
from the spinal cord as medullated fibres through 
the anterior roots of the spinal nerves from second 
dorsal to second lumbar and run as white rami 
communicantes to the ganglia of the lateral chain. 
They never leave the chain as medullated fibres but 
may pass either upward or downward in the chain 
before losing their sheath in the ganglia. An example 
of this is seen in the vaso-motors of the head, face, 
etc. , which emerge from the spinal cord in the second , 
third and fourth spinal nerves, and entering the 
gangliated cord pass upward to the superior cervical 
ganglion, in which they end. 

From the lateral ganglia all the vaso- constrictor 
impulses are carried over pale or sympathetic fibres. 
These may follow in their distribution any of the 
pathways of the gray rami communicates (Chap. Ill, 
page 65) or they may pass directly to the viscera or 



88 
indirectly as gray rami efferentes through* the 
prevertebral plexuses to the viscera. 

The osteopath uses the vaso-motor nerves perhaps 
more often than any other nerves of the body. Aside 
from these there has never been any unequivocal proof 
of the existence of trophic nerves and they are in 
function closely associated with secretion. Their 
disturbance interferes with the function of every gland 
and tissue in the body. The effects of their activity 
are twofold, local and general. The action of the 
vaso-constrictors tends to increase the resistance to the 
blood passing from the arteries into the capillaries and 
into the veins. This effect will increase the work 
thrown upon the heart. This effect will be propor- 
tionate to the degree of constriction and the area 
affected. Its maximum effect would be produced if 
the whole arterial area were affected. Its minimum 
effect is witnessed when a small area is affected. The 
increased amount of work may be counter-balanced by 
the action of a nerve which runs within the vagal 
sheath — the depressor nerve — a nerve which conveys 
sensory impulses from heart to vaso-motor center, 
which impulses diminish arterial tone in other parts 
of the organism, chiefly through the inhibition of the 
vaso-constrictors of the abdominal splanchnics. 



89 

Now the effect of vaso-dilatation is exactly the Effect of vaso- 
dilatation. 
opposite of constriction — a diminution of blood 

pressure everywhere. The general fall will be 

proportional to the area dilated and the amount of the 

dilatation. But in local dilatation the most marked 

effect will be a flushing of the capillaries of the dilated 

area. Just so in local constriction the most noticeable 

effect will be the pallor of the constricted area. 

These changes produce one effect upon the pressure 
in the capillaries, another in the small arteries and 
arterioles. To appreciate this it is necessary to 
remember that the capillary walls consist of plates or 
cells very sparsely wrapped with connective tissue but 
containing no muscle fibres and therefore having no 
vaso- motor control. These cells are capable of 
expansion and of elastic recoil. 

The change in the lumen of the capillary is a 
passive one. When the firm and muscular walls of 
the arterioles are contracted they receive the pressure 
of the blood and resist its surging forward into the 
capillaries. While the pressure against the walls of 
the arterioles has remained unchanged the capillaries 
have received much less blood and therefore are, by 
the innate elasticity of the epithelioid plates much 
reduced in lumen. During dilatation of the arterioles 



90 



Constriction 
decreases 
capillary 
pressure. 



Facts per- 
taining to 
vaso-motore. 



the lateral pressure of the blood must be resisted by 
the capillaries, heuce they are distended. 

To put it briefly, constriction of the arterioles 
decreases capillary pressure; dilatation of the arterioles 
increases capillary pressure. 

Now the vaso-constrictor center is in continual 
action resulting in arterial tone. Any increase, either 
general or local, is called hypertonic ; any decrease is 
a hypotonic condition. Arterial tone is the result of 
the condition of the blood which stimulates the vaso- 
motor center and of the general relation between the 
thermogenic and thermolytic centers and the summa- 
tion of stimuli which stimulate the sensorium from 
without. These conditions are further affected by the 
action of the augmentor and the depressor fibres 
regulating the strength, rapidity and rhythm of the 
heart-beat. Any stimulation of a sensory nerve will 
increase the action of the vaso-motors. 

There are a few well known facts upon which our 
treatment is based : 

First. The cervical sympathetics contain afferent 
fibres which when stimulated excite the vaso-motor 
center in the medulla. 

Second. There is an inverse relation between the 
vessels of the skin and the deeper parts on reflex 
stimulation of the vaso-motor centers. 



91 

Third. The vaso- constrictors are distributed chiefly 
to the viscera and to the cutaneous vessels. The 
vaso-dilators chiefly to the skeletal muscles and to 
some other local structures and glands. 

Fourth. Vaso-motor actions may be inhibited by 
pressure. Cutting off the impulses which would 
enter the center may allay the outgoing ones. 

Fifth. Usually the rate of heart-beat and arterial 
pressure vary inversely, a low peripheral resistance is 
accompanied by a rapid pulse. 

Sixth. In addition to the general bulbar center 
there are subsidiary centers controlling the vaso-motor 
condition of the various viscera. 

Our theory of controlling the vaso-motor condition 
of the body locally and generally is as follows : 

First. By pressure upon the inferior cervical 
ganglion we decrease the rate of the heart-beat ; this 
decrease is followed by a reflex vaso- constriction. 

Second. By varying the pressure put upon the 
splanchnics the mesenteric vessels are constricted 
and a reverse condition prevails in the cutaneous 
capillaries. This is an important point in thermotaxis; 
it serves to regulate the temperature by irradiation 
and by evaporation of the product of the perspiratory 
glands. 



92 



Thermogenic 
center. 



Vaso-motor 
centers for 
organs. 



Third. Steady pressure at the basi-occiput is 
usually considered as holding the vaso-motors. What 
is done is to reduce by mechanical pressure the blood- 
flow to the brain, to quiet the irritated meningeal 
nerves and to reduce the pressure in the arterial twigs 
which nourish the vaso-motor center. This stimulates 
the over-fatigued center to healthy action, increases 
arterial tone, and reduces rate of heart - beat by 
diminishing impulses from the "augmentor center 
situated near the vaso-motor center in the medulla. 

Fourth. The thermogenic center is located in the 
corpus striatum. Pressure on the vertebral artery 
aided by downward pressure on the carotid sheath 
will send less blood to this center, aid in its drainage 
and thus reduce temperature. The splanchnics must 
be stimulated at the same time to aid in thermolysis. 

The following are the vaso-motor centers for the 
various organs, members and viscera : 

Head : The superior cervical ganglion. 

Throat, tonsils, nose, etc., are reached at the same 
point. 

Dilators for tongue and mucous membrane : Fifth 
and ninth cranial nerves. 

Eye : Superior cervical ganglion through fifth 



n erve. 



93 

Brain, anterior and middle fossae : Superior cervical 
ganglion. Posterior and middle fossae : Inferior 
cervical ganglion. 

Muscles of neck : The three cervical ganglia. 

Thyroid gland : Middle and inferior cervical 
ganglia. 




>* CO*' 

PLAN OF AN UPPER DORSAL NERVE, SHOWING THE TYPICAL 

MANNER OF BRANCHING OF THE ANTERIOR AND 

POSTERIOR PRIMARY DIVISIONS OF A 

SEGMENTAL NERVE. 

—(From Quain's Anatomy). 

All of the above make their exit at the first to 
fifth dorsal vertebra, hence any lesion in this or the 
cervical region may affect any of these regions. 



94 

Heart : The vagi. We obtain effects on nutrition of 
heart at the middle and inferior cervical by inhibition. 

Lungs : From second to sixth dorsal. 

Iyiver : The splanchnic area, sixth to tenth. 

Intestines : Fifth dorsal to second lumbar, a 
segmental supply in the order duodenum, jejunum, 
ileum, colon. 

Kidneys : Tenth to twelfth dorsal. 

Spleen : Ninth and tenth dorsal. Vagus contracts 
spleen through its action on muscular trabeculse. 

Portal system : Fifth to tenth dorsal. 

External generative organs, constrictors : First and 
second lumbar to sympathetic and to hypogastric 
plexus, thence through pelvic plexuses or through 
pudicnerve. 

Dilators : First and second sacral via nervi erigentes 
to pelvic plexuses. 

Internal generative organs (both sexes) : First and 
second lumbar. 

Arm, vaso-constrictors : Second and seventh dorsal. 
Vaso-dilators chiefly in motor nerves of the muscles. 

I^eg : Constrictors, sixth dorsal to second lumbar. 
Dilators in sheaths of motor nerves. 

Trunk : Constrictors, at corresponding segments. 
Dilators, in motor nerves to muscles usually. 



CHAPTER V. 



OSTEOPATHIC CENTERS. 

F I ^HE work of the osteopath is in many cases 
-*■ palliative — always in acute cases and usually 
as preparatory treatment in chronic conditions it is 
necessary to reduce muscular contraction. This 
muscular contraction is in many cases a reflex effect 
of stimulation of branches of afferent nerves, other 
branches of which are distributed to the muscles of the 
spine. According to Head's law (Chap. II, page 49) 
these contractions are the result of changed conditions 
in the viscus. To remove these will restore the 
normal circulation to the organ through vaso-motor 
effects and tend to restore the organ to health. This 
contraction is reduced by steady pressure applied to 
the muscles of the back, usually the deeper layers. 
The point at which this produces the most marked 
effect is between the spines and the transverse 
processes. The pressure should be directed upward, 



viscera. 



96 
Sensory outward and forward. Quain gives the sensory nerve 

centers to 

supply to the various viscera as follows : 

Heart : First, second and third dorsal. 

Lungs : First, second, third, fourth and fifth dorsal. 

Stomach : Sixth, seventh, eighth and ninth dorsal. 
Cardiac end from sixth and seventh. Pyloric end from 
ninth. 

Intestines : {a) Down to upper part of rectum, ninth, 
tenth, eleventh and twelfth dorsal, (b) Rectum, 
second, third and fourth sacral. 

L,iver and Gall-bladder : Seventh, eighth, ninth 
and tenth dorsal. 

Kidney and Ureter : Tenth, eleventh and twelfth 
dorsal. Upper part of ureter, tenth dorsal. At lower 
end of ureter, first lumbar tends to appear. 

Bladder : (a) Mucous membrane and neck of 
bladder, second, third and fourth sacral ; (b) over 
distention and ineffectual contraction, eleventh and 
twelth dorsal and first lumbar. 

Prostate : Tenth, eleventh, (twelfth) dorsal, first, 
second and third, and fifth lumbar. 

Epididymis : Eleventh and twelfth dorsal, and first 
lumbar. 

Testis : Tenth dorsal. 

Ovary : Tenth dorsal. 



97 
Appendages, etc.: Eleventh and twelfth dorsal, 
first lumbar. 

Uterus : (a) In contraction, tenth, eleventh and 
twelfth dorsal and first lumbar, (b) Os uteri ; (first) 
second, third and fourth sacral (fifth lumbar very 
rarely). 

Osteopathy bases its claim to rank as a science of ^"^nS 1 ° f 
healing upon the fact that there exists a definite and system. 
fixed relation between an organ and the central nervous 
system. This relation is secured through the 
segmented arrangement of the spinal nerves or through 
the sympathetic system, by means of rami communi- 
cantes. The order of this innervation is fairly constant, 
though, as is the case with other portions of the body, 
it may vary. This variation in no wise invalidates 
the claim of osteopathy to rank as a science, but it does 
emphasize the necessity of our searching for lesions 
even in regions relatively remote from the center. 
Specific treatment in the sense of work exclusively 
upon a region said to be a center is rarely indicated. 
Owing to the diffusion of pain and its attendant con- 
ditions, it is necessary to remove any contracture which 
may be associated with it. Again it sometimes occurs 
that disease of an organ produces no effect on its usual 
center, and in such an event it is necessary to carefully 
examine other regions for the trouble. A case of con- 



98 



"Touching 
the button.' 



Osteopathic 
centers. 



gested ovary was recently related to me in which there 
was no soreness in the usual center, eleventh dorsal, 
nor would persistent treatment directed to this center 
produce any effect, while a marked lesion was found 
at the sacro-iliac synchondrosis and the removal by 
treatment resulted in restoring the normal condition. 
Know the location of the centers. Know also that 
occasionally a lesion causing the trouble must be found 
elsewhere. ' ' Touching the button ' 5 is a fascinating 
method of treating, both in theory and in practice, but 
the operator must be broad enough to expect it to be 
difficult occasionally to locate the button. 

Reminding you again that our use of the term cen- 
ter is in the sense of a convenient and advantageous 
place to reach fibres to or from a certain organ, we 
shall point out some of the more prominent and 
important centers : 

The atlas is associated with disturbances to the vaso- 
motors of the eye, ear, and with eczema and other 
diseases of the face. 

The axis and third cervical is a general vaso-motor 
center, the superior cervical ganglion, center for side 
of head, face, eye, nose, pharynx, tonsils and vessels of 
the brain. 

Third, fourth and fifth cervical, origin of phrenics, 
center for hiccoughs. 



99 

Fifth and sixth cervical, middle cervical ganglion ; 
center for thyroid gland ; also augmentors to heart 
through middle cervical ganglion. 

The general function of the cervical region is that 
of (i) vaso-constrictor effect through sympathetic 
fibres passing into it from below through the second, 
third, fourth and fifth dorsal, and vaso- dilator fibres in 
the cervical spinal nerves, thus affecting all parts of the 
body ; and (2) local vaso-motor effects on the neck, 
head and face of the same side. That the upper 
cervical region is sometimes said to be a center for the 
kidney is based upon its influence over the general 
vaso-motors of the entire body. 

Second, third, fourth, fifth and sixth dorsal are vaso- 
constrictors to the pulmonary blood vessels. 

Third to seventh dorsal, vaso-motors to arm via the 
brachial plexus. 

Seventh cervical and first dorsal, inferior cervical 
ganglion, heart, thyroid gland, vertebral and basilar 
arteries. 

Annul us of Vieussens and second, third, fourth and 
fifth dorsal, augmentory fibres to the heart. 

The first three give regularity of rhythm. 

Fourth and fifth control intermittency and regularity 

of heart-beat. 

U 9f C. 



100 

Fourth dorsal, sometimes third or fifth, stomach 
center on right side usually. General effect as low as 
the eighth. 

Second and third dorsal center for ciliary muscle, 
also muscle of eye. Center for vomiting. 

Sixth to tenth dorsal, origin of the great splanchnic, 
carrying viscero-inhibitory fibres and viscero-con- 
strictor and secretory fibres to the stomach and small 
intestine. 

Eighth, ninth and tenth dorsal on right side, center 
for the liver. This gives us the center for chills, as 
the liver and spleen are implicated in malarial attacks. 

Ninth and tenth dorsal on the left, center for the 
spleen. In treatment of chills the general condition 
must be controlled through cardiac and vaso-motor 
centers, directing especial attention to the liver and 
spleen. Also center for uterus via hypogastric plexus. 

Eleventh and twelfth dorsal and upper lumbar, the 
small intestine and kidney. 

Eleventh and twelfth dorsal, center for ovary. 

Second lumbar, center for parturition, micturition 
and uterus. 

Second, third and fourth lumbar, center for diarrhoea. 

Fourth and fifth lumbar, hypogastric plexus, which 
with fibres from the aortic plexus forms the pelvic 
plexus distributing fibres to the pelvic organs. 



101 

The anterior division of the sacral nerves are 
splanchnic in function and are distributed to the 
rectum, to the bladder, sphincter ani, vagina and 
uterus. These seem to be chiefly viscero-motor in 
function. 

Second and third sacral, bladder. 

Fourth sacral, vagina. 

Fourth and fifth sacral, sphincter ani. 

After a general view of the centers along the spine 

° r Control of 

it is necessary to form a resume of their location by circulation 
mentioning the chief organs of the body and with 
them the regions in whieh they may be affected 
through their vaso-motor and viscero-motor, inhibitory 
and secretory nerve supply. Generally speaking the 
circulation is controlled through the great vaso-motor 
centers, reached in the upper cervical region. It is 
further controlled through the region from which the 
augmentor fibres make their exit — the second to the 
fifth dorsal. It is also affected by treatment in the 
splanchnic region controlling the vaso-motors to the 
great capillary network of the mesenteries. 

That the respiratory activity is closely affected by 
the circulation is known to everyone, so a treatment 
affecting the one in a measure modifies the other. So 
far as is known there is no center for voluntary 
motion other than the exit of the motor nerves along 



102 

the spine. (The physiological center is in the 
encephalon.) 

A spinal lesion may cause a paralysis of all the 
motor apparatus below that lesion, or, if the lesion 
affect a small area of the cord transversely, its effect 
may be limited to a few muscles or to a few groups of 
muscles in a region whose motor nerves pass through 
the affected region. 

Nutrition is likewise dependent upon respiration, 
circulation and the condition of the stomach, 
intestines, liver, etc., so a center for nutrition is 
consequently not to be sought for in any one region. 

The practical value of the foregoing facts is this : 
If the symptoms indicate trouble or disturbance of a 
certain organ, look carefully for lesions in the 
corresponding spinal center. Should other symptoms 
not permit of a differential diagnosis, as is often the 
case, then the existence of a lesion at the center for 
an organ will be an almost infallible evidence of 
disease of that organ. 

In case of a disturbance in any of the following 
organs or members look for your spinal lesions as 
follows : 

Pharynx, larynx and tonsils: Second and third 
cervical. 



103 
Thyroid gland : Fifth and sixth cervical; general cent&rfor 

thyroid gland 

vaso-motor and cardiac center, seventh cervical and 
first dorsal — head of first rib ; clavicle. 

Arm, motion, vaso-motor and nutrition : Brachial 
plexus in fifth, sixth, seventh, eighth cervical and first 
dorsal. Also vaso-motors in third to seventh dorsal. 

Lungs and bronchi : Second to sixth or eighth 
dorsal ; also vagus nerve. 

Heart : Fibres from second to fifth dorsal, special 
attention to fifth dorsal. Heart may also be reached 
through middle and inferior cervical ganglion, and at 
first rib, or annulus of Vieussens. 

Stomach : Third to fifth dorsal specific on right 
side, third to eighth generally ; also vagus.. 

Liver : Ninth and tenth dorsal, vaso-motor, vagus 
motor. 

Spleen : Eighth to eleventh dorsal, vaso-motor, 
vagus motor. 

Duodenum : Great splanchnic, sixth to tenth dorsal. 

Jejunum and ileum : Lower dorsal and lumbar to 
fourth and fibres from solar plexus. 

Colon : Second to fifth lumbar. Also fibres from 
solar plexus. 

Rectum : Second to fifth lumbar via inferior 
mesenteric plexus, inhibitory. Sacral, via hypo- 
gastric plexus, motor ; also third and fourth dorsal. 



104 
* In the treatment of the abdominal viscera in addition 
to the specific treatment it is always beneficial to give 
direct treatment to the abdomen, paying particular 
attention to the region of the solar plexus. This has 
the effect of changing the blood by sheer compression, 
thus relieving venosity and allaying increased peris- 
talsis ; or in case of sluggishness of any organ it 
stimulates the plexuses of Auerbach and Meissner to 
motion and secretion. It may also break up masses of 
fecal matter lying within the abdominal canal. 

Uterus: Second to fifth lumbar, ninth and tenth 
dorsal. 

Genitalia generally : Second to fifth lumbar. 

Bladder : Second, third and fourth sacral. 

Sphincter ani : Fifth sacral. 

The knowledge of the location of these centers is of 
incalculable advantage to the osteopath since it is 
upon this knowledge that the accuracy of his treat- 
ment depends, and since so much of the osteopaths' 
success is dependent upon the accuracy of his 
diagnosis this must be available knowledge. An 
osseous lesion in the area which we have designated as 
a center for a certain organ may lead to a diseased 
condition of that organ ; while a lesion of an organ 
may manifest itself in tenderness within its center 



105 

along the spine. This tenderness may be found in the 
following localities : 

i. On the ends of the spinous processes, usually- 
indicating an anterior condition. 

2. Above the spinous processes and about an inch 
lateral at the articulation of the rib with the transverse 
process of the vertebra, indicating a lateral movement 
and often a tipping forward of the body of the 
vertebra. 

3. The soreness may be manifested at the angle of Locationo f 
the rib, indicating a rotation of the rib upward or 
downward on the axis connecting its two extremities. 

4. Associated with any of these three conditions 
may be found soreness in the muscles lying in that 
region on either side of the spinous process. 

To determine these conditions the patient should be 
sitting. 

Gentle pressure will determine any sensitiveness. 
To examine the angles of the ribs in the interscapular 
region the arm on the same side should be grasped at 
the elbow and firmly passed across the chest. This 
will tighten the muscles and expose the rib from the 
covering of the scapula. In all these cases the 
muscular contraction must be released ; to do this the 
patient should be placed upon the table and a firm and 
steady pressure applied to the muscles, the skin being 



106 
lax, passing either upward or downward. This will 
release the pressure and may be sufficient in acute 
cases. In addition to this, an oscillation of the body 
from side to side bending at the lesion will prove 
helpful, as will rotation around the same point. 
Springing the spine forward will produce a good 
effect by releasing muscular and ligamentous con- 
tractures. 



CHAPTER VI. 



THEORY OF THE TREATMENT OF THE SPINE. 

SINCE so large a part of our treatment is directed 
toward the seat of the trouble via the spinal 
nerves, it is necessary that we defend ourselves and 
our science by rationally explaining the modus curandi 
of osteopathic manipulations. It is necessary to recall 
to mind the relation of the central nervous system to 
the sympathetic through the rami communicantes, and 
also the function of the sympathetic in distributing 
secretory, nutritive, sensory viscero-motor and vaso- 
motor impulses. Leaving out all disputed points we 
take the primary facts upon which all physiologists 
and anatomists are practically agreed, viz. : 

(i) That from the entire length of the cerebro- 
spinal center vaso-dilator fibres make their exit. 

(2) That the vaso- constrictors are confined in their 
exit to the region of the cord lying between the 
second dorsal to the second lumbar inclusive. 



108 



Non-aerated 
blood an 
stimulat to 
peristalsis. 



(3) That the viscero- motor go largely through the 
vagus nerve to the stomach and intestines. 

(4) That the sympathetics are the great vaso- 
constrictor and viscero-inhibitors to the solar and 
related plexuses. 

(5) Sensory fibres from the viscera pass through 
the sympathetics to the spinal nerves. 

(6) Inhibition of nerve action may be procured 
reflexly. Pressure on one branch of the nerve will 
quiet pain in other branches. 

(7) The motor, vaso-motor and secretory conditions 
of a viscus are controlled by the condition of the 
nerve center controlling that organ ; hence affecting 
the sensory nerve affects the viscus. 

It is necessary to remember that non-aerated blood 
is the greatest stimulant to peristalsis ; pain and 
cramping are often only an evidence of increased 
peristalsis. 

Any change in the blood supply to the stomach and 
intestine has its direct effect upon the nutrition of the 
body, influencing both digestion and absorption ; also 
it has its effect on excretion through the kidneys. 
Thus it is plain that the region that controls nutrition 
and excretion is of vast importance in regulating the 
general welfare of the organism. 



109 

Dr. L,. Hart's theory was as follows: " Through Dr. Hart's 

theory. 
stimulation of vaso-motors distributed to the vessels 

in the muscles along the spine we produce a constric- 
tion of these peripheral vessels which thus increases 
the pressure in the collateral branches of these arteries, 
increasing the pressure of the blood in the vessels 
within the cord itself. ' ' 

This treatment is, according to Dr. Hart's theory, 
directed toward regulating the blood supply to the 
nerve cells within the spinal cord, and through over- 
coming hyperaemia or anaemia of the center restore 
normal functioning to both nerve and organ with 
which it is anatomically connected. 

Another 

Another theory which seems much more in accord theory. 
with our immediate results obtained in acute cases or 
in giving immediate relief to exacerbations of pain is 
here given. 

Our theory is this : First, we inhibit the passage of 
afferent impulses by pressure on the posterior sensory 
portions of spinal nerves. This reduces the impulses 
sent in, quieting the pain by quieting the center. We 
reduce muscular contractions which have irritated both 
efferent and afferent fibres to the viscera. These con- 
tractions have caused a venous stasis in the capillaries 
of the muscles themselves irritating the posterior sen- 
sory nerves which reflexly affect the viscera. 



110 
We remove irritation from the vaso-constrictors 
allowing normal blood supply to be re-established. We 
stretch the connective tissue and take off pressure from 
the nerve trunks. We equalize the nerve tension be- 
tween center and periphery. 

In order to appreciate this theory it is necessary 
to grasp the philosophy of transferred or sympa- 
thetic pains. This is a fact long known to the med- 
ical profession though poorly utilized by them in 
diagnosing disease. Investigations by Head prove 
that in diseases of internal organs manifestations of 
this condition will be made by tenderness in widely 
removed parts, the diseased organ and the region 
manifesting the tenderness having a fixed relationship. 
Thus toothache may cause pain in the ear, heart 
trouble may cause a localized pain between the 
shoulders, kidney trouble manifests itself by pain in 
the back. Careful investigation will reveal the fact 
that the soreness is not in most instances associated 
with the skin alone but that the tenderness is found 
in the muscles beneath. Head explains the topo- 
Head'siaw. graphical association of tenderness with visceral 
disorders by the assumption that the nerves supplying 
the regions thus related have their origin within the 
same segment of the spinal cord. The viscera are 
regions of low sensibility while the skin and muscles 



Ill 

are more freely supplied with sensory fibres and may 
be called regions of high sensibility. The sensory 
result of visceral irritation or lesion is summarized 
thus : " When painful stimulus is applied to a part of 
low sensibility in close central connection with a part of 
much greater sensibility, the pain produced is felt in 
the part of higher sensibility rather than in the part of 
low sensibility to which the stimulus was actually 
applied. ' ' This law is proved both by experiment and 
clinical practice. But clinical observation further 
shows that the converse of that proposition is true. 
Constant irritation or stimulation in a region of high 
sensibility in close central connection with a viscus 
will produce both functional and structural disturbance 
in the viscus as well as sensitiveness in the region 
stimulated. That such stimulation exists cannot be 
doubted. Trauma may produce slips or minor 
dislocations. Anaemia allows a relaxation which will 
favor such conditions. Cold, constant labor, over- 
work, general excitement may produce muscular 
contractions which often remain permanent. Thus 
osseous, ligamentous or muscular pressure may serve 
as a stimulus, which, having its first effect on a 
region of high sensibility, will soon manifest itself in 
some irregularity of the organ. Then the radical 
treatment will be to remove the irritation by over- 



112 

coming muscular contraction, or pressure upon the 
nerve from whatever source. That a muscle devoid 
of irritation may be made to contract is a simple 
physiological fact easily proven. That steady pressure 
accompanied by a stretching motion forcibly applied 
to a contracted muscle will cause it to relax is also 
proven in osteopathic practice daily. Again it is a 
physiological axiom that prolonged stimulation of a 
nerve causes it to fail to function ; hence, irritation of 
a nerve, the result of contracture, ultimately causes 
loss of tone to and function of the organ supplied by 
that nerve, — or, in other words, prolonged stimulation 
serves to inhibit. 

In conditions of anaemia of an organ, contraction 
of muscles and tenderness of superficial nerves coming 
from corresponding segments of the cord are always 
found. 

Now, our chief object, if the foregoing statements 
are correct, is to relieve contracture, and whether the 
condition be one of anaemia or hyperemia the removal 
of this condition will allow a restoration of the normal 
condition. This explains . why one often obtains 
the same result from a stimulating treatment as from 
an inhibitory one. 

The case is markedly different in the cervical region 
where one may apply direct stimulation or inhibition 



113 

.to the sympathetics and to the vagus for the heart and Direct effect in 

cervical and 
viscera. sacral regions. 

It is also different in the sacral region, for there you 
work on the posterior division of the sacral nerves 
while the anterior division is splanchnic in function 
and distribution, thus allowing a more direct effect 
without any intervention of the sympathetics. 

First. We correct osseous lesions which have 
interfered with any of the classes of nerves to the 
disturbed viscus. 

Second. Immediate effects are produced by 
reducing muscular contractures which have irritated 
the somatic branches of motor, sensory, vaso-motor 
and secretory nerves to the viscera. Irritation 
removed, the nerves return to normal. 

Third. Steady pressure on the posterior divisions 
of the spinal nerves inhibits sensory, and vaso-motor 
impulses to and from the center, thus retarding all 
forms of activity. Rapid alteration of pressure 
increases activity of the organ thus increasing 
impulses to it. 

Fourth. Steady pressure may restore visceral life 
by removing muscular contracture which has served 
as an inhibition. 



114 
THE EXAMINATION OF THE SPINE. 
That we may intelligently examine a spine we 
should be thoroughly acquainted with the general 
topography of the back. I shall after Holden give 
you a brief outline of the landmarks of the back. It 
must be remembered that the normal spine has four 
curves, as follows: (i) The cervical, concave back- 
ward, extending from the apex of the odontoid to the 
second dorsal. (2) Beginning at the middle of the 
second dorsal and extending to the twelfth, its 
concavity forward is the dorsal curve. The most 

The spinal 

curves. prominent point is at the seventh and eighth dorsal. 

(3) The lumbar curve, from the middle of the twelfth 
dorsal down to the angle between the fifth lumbar and 
the base of the sacrum, its concavity being directed 
backward. (4) From the base of the sacrum to the tip 
of the coccyx, its concavity forward, is the pelvic curve. 
Care must be taken to become thoroughly familiar 
with the normal in order that any variation from this 
type may be detected. There will be variations 
within a limited range, even in health. The dorsal 
and pelvic curves are primary and are due to the shape 
of the vertebrae, while the cervical and lumbar are 
secondary and compensatory and exist only after 
birth, their existence being due to modifications in the 
form of the intervertebral discs. There is one point 



115 

in which the beginner is apt to be deceived, 
particularly in the female. The lumbar curve 
beginning at the sacro-vertebral articulation, drops 
forward very abruptly and if this should be further 
increased in appearance by well developed nates, the 
operator may be deceived. The test must be made by 
a careful examination for tenderness on pressure. 
The spine should lie in a perpendicular plane while 
the patient is sitting or standing erect, though there 
is often a slight lateral curvature in the dorsal region, 
the convexity of which is directed toward the hand 
which is habitually used. This is doubtless caused by 
the increased strength of the muscles of that side and 
also the compensatory position taken by the head and 
cervical region. Again the tips of the vertebral 
spines should lie in a perpendicular plane, which may 
be tested by bringing the hand briskly down over the 
spines either directly over it or with two fingers, one 
on each side of the prominences of the spines. By 
this method one may detect any deviation from the 
usual position, and if tenderness be present this may 
serve as an evidence of a lesion, and reasoning from 
cause to effect, the organ or organs affected may with 
certainty be determined. But care must be used in 
the matter of finding a lesion. The atlas has no 
spine, only a mere tubercle and no surprise should be 



116 

manifested at finding it ' ' forward. ' ' The second 
cervical is perhaps the most prominent feature in the 
cervical region of a normal spine and its widely 
bifurcating and massive spinous process may give the 
beginner some uneasiness. The cervical spines are 
bifid from the second to the sixth inclusive. The 
vertebra prominens is close to the first dorsal, the 
latter very commonly being mistaken for it. 

To examine, bare the spine, have the patient sit 
erect. Note the curves whether they be normal, 
indications. diminished or accentuated. A flat region in the upper 
dorsal means lung and heart action impaired, and 
weakened vitality. If the fifth to tenth dorsal are 
anterior, or if the lumbar, dorsal and cervical are 
almost in line there will be stomach and intestinal 
disorders. Any marked deviation from the normal 
curve in the lumbar region may result in constipation, 
ovarian or uterine disorder, or it may cause derange- 
ment of the function of the bladder. The sacral 
vertebra are relative to each other always in place but 
they may be slightly out of their true articulation 
with either the auricular processes of the ilium or 
with the lumbar vertebra above or the coccyx below. 
In lesions of the lumbo-sacral and sacro-iliac articula- 
tions you will find pelvic disturbances. The coccyx 
may by dislocation cause constipation, haemorrhoids 



117 
and piles. Detect any lateral curves that may be 
present by careful inspection. Friction will bring into 
view .the spines and any marked separation or 
deviation from the perpendicular, the patient sitting 
erect, should call for careful palpation. 

Locate the second cervical by its prominence. The 
first dorsal by the length of its spinous process. The Landmarks. 
third dorsal by the level of the scapular spine. The 
seventh dorsal by the angle of the scapula. The fourth 
lumbar by the fact that a line from the iliac crests will 
pass through its body. 

The twelfth dorsal may be conveniently located by 
having the patient fold his arms and lean forward thus 
throwing into prominence the trapezii, whose converg- 
ing external borders will indicate the twelfth spine or 
better by the articulation with the last rib or by the 
natural break between it and the first lumbar. After 
being satisfied with inspection, a careful examination 
with the hand will detect any irregularity that the 
eye may overlook. The spines are the key to the 
situation, but the tenderness in addition to abnormal 
position must be found. 

Each operator will have his preference for position 

Positions for 
of the patient. For a thorough examination many laminations. 

positions may be necessary. The following order is 

suggested, the back being exposed in all cases : 



118 

First. Patient sits erect, operator standing behind. 

Second. Patient leans forward, sitting squarely, 
hands on knees. 

Third. The patient is placed facing operator, first 
on right and then on left side. The operator carefully 
examines each spine and transverse process in 
succession. During this examination the patient 
must thoroughly relax. The operator uses arms and 
legs of patient as levers for movement in examination. 

Fourth. Patient on back, body straight so that 
nose, chin and point between feet are in straight line, 
arms at sides. The operator now stands at head and 
examines both sides of vertebrae of neck. The spines 
of cervical vertebrae cannot be relied upon for diagnosis 
so we examine transverse processes. Deviation from 
a straight line either antero-posteriorly or laterally 
indicates trouble at that point. An examination of its 
spine will usually confirm this result. The atlas can 
be examined only at its transverse process which 
should be easily felt about half way between mastoid 
process and the decending ramus of the inferior 
maxilla. Tenderness is usually, if not always, 
most pronounced on the side of the slip. The end of 
the little finger may usually be passed between the 
transverse process and the ramus of the jaw if in 
normal position. 






CHAPTER VII. 



REGIONS OF HEAD AND THORAX. 

' I ^HE covering of the upper part of the head is 
-*- called the scalp. It consists of skin over an 
aponeurosis of the occipito-frontalis muscle, which be- 
comes muscular in front and behind. The chief bony 
prominences are the occipital protuberance behind, 
the mastoid process just behind and on a level with 
the lobule of the ear, and the zygoma. 

The arteries of the scalp are the supraorbital, mak- 

Arteries and 

ing its exit at the supraorbital notch; the temporal ^f es/or 
from the external carotid passing up in front of the 
ear, distributed to the anterior and middle part of the 
scalp ; the posterior auricular to the posterior part of 
the scalp passes posterior to the apex of the mastoid 
process the occipital from the external carotid. 

The nerves supplying sensory fibres to the scalp are 
the supratrochlear, reached at the inner angle of the 
orbit, the supraorbital reached above the supraorbital 



120 
notch, the temporal branch of the tempo-malar half- 
way between the eye and upper margin of ear, and the 
auriculo-temporal best reached in front of tragus. 
These are all branches of the fifth nerve. In addition 
the small occipital and great occipital innervate the 
posterior portion of the scalp. These are both from 
the second cervical and may be reached at their exit. 

These nerves are frequently affected in headaches. 
Pressure at the points named will relieve this con- 
dition. 

The muscles of the face, excepting those of mastica- 
tion, are supplied by the seventh nerve. This nerve 
makes it exit from the stylo-mastoid foramen, anterior 
to the mastoid process, and may be reached between 
the mastoid process and the ramus of the jaw. 
Fifth nerve. The sensory nerve of the face is the fifth, supplying 

also the muscles of mastication. This nerve is affected 
in neuralgia and is treated by steady pressure at the 
following points : At the supraorbital notch and at 
the infraorbital and mental foramina. A line passed 
from the supraorbital notch to a point between the two 
bicuspid teeth will pass through these points. Indi- 
rectly it may be reached through its sensory distribu- 
tion from Meckel's ganglion, lying in the spheno- 
maxillary fossa. 



121 

The arteries to the face are, the facial and branches 
from the temporal. The facial may be felt as it crosses 
the horizontal ramus of the lower jaw. 

The mouth requires much attention in disease. The 
points which the osteopath may reach within this are 
the uvula, in the middle line posteriorly, the posterior 
nerves to be reached and pressed upon in catarrh, the 
tonsils latterly between the anterior and posterior pil- 
lars of the fauces. 

The pits into which open the Eustachian tubes may 
be reached in the posterior and lateral portion of the 
pharynx. The ninth nerve supplies the tonsils, part 
of pharynx, Eustachian tube and % tympanum with 
sensory fibres. Treatment of this nerve is necessary 
in catarrhal deafness. 

The neck is one of the most important regions of 
the body to the osteopath. Its drainage is accomp- 

The neck. 

lished largely through the external and the anterior 
jugular veins, the former in line from the angle of the 
jaw to the middle of the clavicle, the anterior lying in 
front of the sterno-cleido-mastoid. The internal carotid 
lies in the carotid sheath, extending from the mastoid 
process to the inner end of the clavicle. The first two 
mentioned are superficial and pulsate in case of tricus- 
pid incompetency. In the neck, in front, lie the 
trachea, the larynx, the hyoid bone, the latter felt just 
on a level with the inferior maxilla. 



Contracture 



122 

Beneath the sternoclavicular joint lie the innom- 
inate veins, the common carotid on the left and a divis- 
ion of the innominate on the right. Rising into the 
neck may be felt the subclavian artery. 

The important muscles in the front of the neck are 
the sterno-hyoid and sterno- thyroid. At the side is 
the sterno-cleido-mastoid, while deeper lie the scaleni, 
the rectus capitus anticus major and minor, and the 
longus colli. Contracture of these muscles is often an 
drainage Wl interference to drainage of the organs in the head and 
neck. The muscles in the posterior portion of the 
neck, which the osteopath is called upon to relax, are 
trapezius, levator anguli scapulae and the rhomboids. 
More deeply lie the serratus superior and splenius. 
Beneath these are the muscles which correspond to the 
erector spinae and still more deeply are the complexus, 
the rectus capitis posticus major and minor, and the 
obliquii. Deep in the neck may be felt the transverse 
processes and their corresponding spines. Superfici- 
ally in the middle line behind, is the ligamentum 
nuchse. This may be stretched by holding the trunk 
and pushing the head and neck downward and for- 
ward. 

The vertebral artery may be compressed as it passes 
over the atlas just beneath the base of the skull. 
This is a point useful in treating headache. 



123 



Anterior 
thoracio 



For examination the thorax is divided into four 
regions, anterior, posterior and two lateral. 

The anterior is surrounded by a line passing 
through the upper ring of the trachea, horizontally to r 
the sterno-cleido-mastoid, thence to the inner end of 
the outer fourth of the clavicle. From this point it 
is bounded laterally by the anterior axillary line, 
which, extending downward, passes through the point 




DIAGRAM SHOWING SUBDIVISIONS OF THE ANTERIOR 
REGION OF THE THORAX. 



(1) Supra-Clavicular. 

(2) Clavicular. 

(3) Infra-Clavicular. 

(4) Mammary. 

(5) Infra-Mammary. 

(6) Supra-Sternal. 



(7) Superior Sternal. 

( 8 ) Inferior Sternal. 

( 9 ) Area for Pulmonary sound. 

(10) Area for Aortic sound. 

(11) Area for Tricuspid sound. 



Mitral sound is heard at point of cardiac impulse over apex of 
heart. 



124 
at which the pectorales muscles leave the chest, ending 
at the lower margin of the twelfth rib. Inferiorly it 
is bounded by the inferior margin of the twelfth ribs 
and lower end of the sternum. This area is sub- 
divided into a middle portion by the sternum and that 
region lying within the sterno-cleido-mastoid muscles 
above the sternum inferior to the line forming the 
superior boundary of the anterior area. 

That portion of the middle region lying above the 
supra sternum is called the suprasternal region. It contains 

scapular 

region. ^ e U pp er p ar t f j-^ oesophagus and the trachea. 

Within this area also lies the vagi nerves, the common 
carotid arteries and the jugular veins, three very 
important structures. The phrenic nerves may be 
• reached in this region as they pass into the thorax 
beneath the sterno-cleido-mastoid muscles. The 
sterno-hyoid and sterno-thyroid muscles are within this 
space and lie anterior to a most important structure, — 
the thyroid gland. This body lies on either side of 
the trachea and is connected by a bridge of glandular 
structure covering the second, third and fourth 
tracheal rings. The lateral lobes of the gland lie 
upon the inferior constrictor of the pharynx superiorly, 
and lower lies upon and external to the trachea. 
Posterior to it lie the carotid sheath and the inferior 
thyroid artery and the recurrent laryngeal nerve. 



125 
The lower portion of the gland lies beneath the omo- 
hyoid, the sterno-hyoid and the sterno-thyroid 
muscles. This gland is of interest to the osteopath in 

Thyroid gland. 

goiter. The muscles above mentioned are contracted 
in case of enlargement of the gland. The veins 
draining this structure are the superior and middle 
thyroid veins emptying into the internal jugular, and 
the inferior tigroid emptying into the innominate. 
The arteries supplying it are the superior thyroid from 
the external carotid, the inferior thyroid from the 
thyroid axis of the subclavian artery and occasionally 
a branch from the innominate or the aorta, the media 
or thyroidea ima. Its nerves are from the middle and 
inferior ganglia of the cervical sympathetic. On 
account of the exceedingly rich vascular supply to 
this organ and its peculiar relation to vaso-motor 
disturbances, treatment should be toward regulating 
the vaso-motor through the cervical region. There 
may be physical obstruction to the drainage through 
the muscular contractures. Or there may be com- 
pression of the subclavian artery owing to a depressed 
clavicle, or an elevated first rib. Careful examination 
should always be made of the head of the first rib in 
such a case, as tenderness there may indicate it is 
turned. 



126 
To the structures lying within this region let us add 
the apex of the lung extending an inch above the 
clavicle, lying deep behind the sterno-mastoid and 
sterno-thyroid muscles. This portion of the lung is 
peculiarly liable to tubercular infection and should be 
carefully examined. The laryngeal nerves are also 
reached in this region. 

The superior sternal region is of comparatively 
little importance from the osteopathic standpoint, save 
in diagnosis. It is separated from the inferior sternal 
region by a line drawn on a level with the upper 
margin of the third rib. 

The inferior sternal region corresponds to that por- 
tion of the sternum lying below the line above men- 
tioned. Covered as are these regions, they are diffi- 
cult to reach, and it is through spinal treatment that 
the osteopath secures his results. In the superior 
sternal region the vena cava descendens, the pulmon- 
ary artery and the bifurcation of the trachea are found, 
while the lung tissue encroaches upon this area below 
the level of the second costal cartilage. 

In the inferior sternal region are found a portion of 
the right auricle, the beginning of the aorta, and the 
pulmonary artery. The right ventricle lies largely 
within this space, while both lungs, the left and the 
right, and the liver contribute to filling it. There 



127 

may be malformations of the sternum as a result of 
dress, occupation, or a rachitic condition in early child- 
hood. Very little can be done to overcome this condi- 
tion, though by pressure on the sternum and traction 
on the lateral thoracic walls by means of the pectoral 
muscles, the lateral diameter of the chest may be 
increased. This treatment may be very effective if 
administered in the early stages of the disease. 

In the supraclavicular region is an important struc- 
ture, the subclavian artery. Its pulsations can be seen fegion} ar 
and felt near the outer border of the sterno-mastoid 
muscle, about an inch above the clavicle. We may 
desire to compress the artery in this position just as it 
crosses over the first rib. It is here that we may 
reach the annulus of Vieussens and the trunks of the 
brachial plexus. To treat this region, it is usually 
most convenient to stand behind the patient ; while 
the patient sits, with the head slightly inclined toward 
the side treated. The arm is used as a lever to throw 
the structures in different relations to each other, thus 
insuring the effect of the manipulations. In this 
region the relation of the first rib to the clavicle may 
be detected. Normally the end of the finger or 
thumb may be pushed between the two. In case the 
clavicle is depressed it can be raised by passing the 
thumb beneath the clavicle near its middle portion and 



128 
using the arm as a lever throwing it upward, outwards 
and forwards there will be felt pressure on the thumb, 
thus elevating the sternal portion. The operator must 
remember that the shoulder is easily dislocated and 
must use due care that no injury is done. A depressed 
clavicle may obstruct the subclavian vein. 
infraciavim- The structures lying beneath the clavicles and the 

lar region. 

upper portion of the sternum are of great importance 
to the osteopath, including the vessels of which we 
have spoken, the internal mammary artery and the 
phrenic and pneumogastric nerves. 

The infraclavicular regions extend from the lower 
margin of the clavicles to the inferior border of the 
third rib and are almost wholly filled with lung tissue. 
It is here that phthisis usually manifests itself, so that 
the study of this region is important. There is a 
marked difference in the position of the two bronchi: 
the right, larger and more horizontal than the left, 
enters the lung at the level of the second costal carti- 
lage at its upper border ; the left passing beneath the 
aortic arch, reaches the lung an inch lower, beneath 
the third costal cartilage. This makes some slight 
difference in the tympanitic note of these regions. At 
the point of union of the second rib and cartilage the 
aortic sound is best heard on the right side, while in 
the corresponding position on the left side the pulmon- 



129 
ary sound is heard. The right infraclavicular region 
contains lung tissue, the vena cava descendens and the 
right bronchus. The left side contains lung tissue, 
the left bronchus and the pulmonary artery, the base 
of the heart and a part of the ascending, transverse 
and descending portions of the arch of the aorta. 
This region often manifests tenderness on pressure in 
case of diseased condition of the lung and should be 
carefully examined. The costo-chondral articulations 
very frequently in such cases show most marked 
tenderness. 

At the outer extremity of this region, extending 
downward from the coracoid process to the upper mar- 
gin of the pectoralis minor muscle is the costo-cor-acoid 
membrane. It lies over the subclavian vessels and is 
pierced by the cephalic vein, acromial thoracic artery 
and vein, the superior thoracic artery and the anterior 
thoracic nerves to the pectorales muscles. Its impor- 
tance cannot be overestimated in cases of rheumatic 
conditions of pectoral and deltoid muscles, also in 
drainage to arm and shoulder. The mammary region, 
extending from the infraclavicular to the inferior mar- 
gin of the sixth rib, contains lung tissue, while the 
heart lies within the mammary and inferior sternal and 
infraclavicular regions. Its base lies almost exactly on 
the level of the third rib. The apex lies at a point 



Costo- coracoid 
membrane. 



Infra-mam- 
mary region. 



130 
midway between the mammary and parasternal lines in 
the fifth interspace, an inch and a half below and an 
inch median to the nipple. It extends three-quarters 
of an inch to the right of the sternum. The area of 
superficial cardiac dullness is confined to the left mam- 
mary region. The right side contains in the mammary 
region the lung, the right auricle and ventricle ; the 
left side, the left lung and the heart. 

The infra-mammary region, lying below the inferior 
margin of the sixth rib, contains the corresponding 
lung, on deep inspection, and the corresponding lobe 
of the liver. The right infra-mammary affords the 
point beneath its inner boundary for directly stimulat- 
ing the liver, one of the most potent methods of over- 
coming torpidity of the liver and curing constipation. 
To treat the liver at this point the patient should be 
either on his back or on his left side, the knees and 
thighs both gently flexed to loosen the wall of the 
abdominal region ; then with the hand placed just 
internal to the line of the cartilages the patient is told 
to take a deep breath and then exhale. Synchronous 
with the exhalation the operator presses forcibly 
upward and outward. Under the dependent portion of 
the liver, at a point just below the middle of the inner 
border of this region, lies the bile cyst, its fundus 
sometimes extending below the margin of the liver, 



131 

under which circumstances it may be easily felt. 
Pressure and stimulation here tends to empty the cyst 
by increasing the peristalsis of the cyst, rather than 
by forcible ejection. The fundus of the stomach lies 
chiefly within the left infra-mammary region and 
extends well up into the mammary area, while the 
pyloric end stretches across and ends under the right, 
thus placing a part of the duodenum and the hepatic 
flexure of the colon beneath this area, the splenic flex- 
ure of the colon entering the left. 

The lateral areas, the right and left, extend from 
the anterior axillary line in front to the anterior mar- Lateral areas - 
gin of the axillary scapula posteriorly. Above it is 
bounded by the axilla and below by the margin of 
the false ribs. A line drawn from the level of the 
superior border of the sixth rib to the inferior angle of 
the scapula divides this region into an axillary region 
above and the infraaxillary below. Within this 
region, behind the pectoralis muscles, may be felt the 
pulsations of the axillary artery, which here gives off 
branches supplying the structures forming the lateral 
wall, while the brachial plexus of nerves may be very 
markedly affected in this region. The drainage of the 
arm may be influenced by treating here the lym- 
phatics of the axilla and the axillary vein. The 
branches of the intercostal nerves in this region are 



Posterior 
region. 



132 
particularly sensitive in case of any abnormality in 
the position of the ribs, and on the left side they will 
reflect any disturbance in function or structure of the 
heart ; on either side, lungs and bronchi. The main 
bronchi are placed deeply within this area. 

The infraaxillary regions contain beneath their 
surfaces lung tissue. In addition, the right one con- 
tains the right lobe of the liver. The left also con- 
tains the spleen and the fundus of the stomach. 

The posterior region of the chest extends from the 
first dorsal spine along the boundary of the supra- 
spinous fossae to acromion process, thence along the 
axillary margin of the scapula to the inferior angle, 
thence perpendicularly downward to the lower border 
of the twelfth rib, thence along the border of that rib 
to the twelfth spine. The same direction on the other 
side gives the completed boundary. A horizontal line 
through the inferior angle of the scapula divides it into 
a subscapular region below, further subdivided into a 
right and left, while the superior portion is again sub- 
divided into a suprascapular region, lying above the 
scapular spine on either side corresponding to the 
suprascapular fossae, a scapular region corresponding to 
the infraspinous fossae, and a region lying between 
these, the interspinous region. The suprascapular 
regions cover the apices of the lungs, and contain 



133 




DIAGRAM SHOWING DORSAL THORACIC REGION AND 
ITS SUBDIVISIONS. 



(1) Supra-Scapular. 

(2) Scapular. 



(3) Sub-Scapular. 

(4) Inter Scapular. 



supraspinal muscles covered by trapezii. The supra- 
scapular nerve passes in through the suprascapular 
notch and, passing downward under the acromion pro- 
cess, is distributed to the infraspinatus muscle. We 
here treat the deltoid muscle through its nerve, the 
circumflex, which is distributed to the skin over the 
shoulder joint, and to the teres minor and the deltoid. 
This nerve, a branch from the posterior cord of the 
brachial plexus, has its origin in fibres coming from 



Scapular 
region. 



134 
the fifth, sixth, seventh and eighth cervical, inclusive. 
Lying beneath this region is the substance of the lung. 

The scapular area reaches to the eighth rib and 
corresponds to the infraspinous fossa, though it 
extends more lateral than it. It is filled in by the tra- 
pezius and infraspinatus muscles, while the lower and 
lateral portion is crossed by the latissimus dorsi and 
teres major muscles. The relation of the latissimus 
dorsi to the scapula is an important one, serving to 
bind the scapula down at its inferior angle. Beneath 
the scapula lies the subscapularis muscle. It is worthy 
of note that the latissimus dorsi, the teres major and 
the subscapularis having related functions are supplied 
by the subscapular nerves, which, like the circumflex, 
take origin from the cervical nerves, the fifth, sixth, 
seventh and eighth. The deep contents of the scapu- 
lar region are lung tissue. Its chief importance to 
the osteopath consists in its relation to the shoulder, 
and the further fact that the scapula offers a leverage 
on his patient. 

The infrascapular regions contain lung and kidney 
on either side and on the right a large portion of the 
right lobe of the liver ; on the left side, part of the 
spleen and the splenic flexure of the colon. 

The right subscapular area should be examined 
most carefully, as in this region tenderness, either 



135 
superficial or intercostal, may manifest itself. This is 
the liver region, and tenderness over it or deeply 
beneath it means some disturbance in liver structure 
or function. At the spine are the centers for the liver, 
the kidney, the spleen and the small intestine. In 
fact, of so great importance is the spinal region of the 
cervix, thorax, abdomen and pelvis, bounded laterally 
by lines drawn through the tips of the transverse pro- 
cesses of the vertebra in the cervical region, the 
angles of the ribs in the dorsal, the transverse pro- 
cesses in the lumbar and the lateral margins of the 
sacrum and coccyx in the pelvic region, that this 
should be designated the spinal region. 

In the interscapular region on either side lie the ^ln. cavular 
lung, bronchial glands, the main bronchus ; while the 
left side contains in addition the aorta, oesophagus and 
thoracic duct. Within this interscapular region are 
the following centers : The lungs and bronchial 
tubes, the stomach, the liver, the upper part of the 
small intestine, and the augmentor fibres to the heart. 
The muscles of the space are the trapezius, covering 
the whole area, the latissimus dorsi which covers the 
lower portion. Connecting the scapula with the spine 
are the rhomboidei major and minor and the levator 
anguli scapulae and more deeply lying are the splenius 
capitis et colli and erector spinae. In case of trouble 



136 
in any organ supplied by nerves from this region of the 
cord there will be tenderness on pressure applied to 
these muscles. This is the logical result of a con- 
tracture of muscles, and before the normal and natural 
impulses can pass along the efferent and afferent fibres 
all such contractures must be eliminated. Thus we 
work upon the muscles indicated. To do this most 
advantageously use the arm as a lever and by pressure 
on the muscles overcome their contraction. It is 
through muscles largely that we secure our ends, and 
by removing the inhibition or the irritation which re- 
sults from their pressure upon the nerves the normal 
conditions are restored. 
Examination To examine the chest the patient should be stripped 

of chest. 

of clothing to the waist, except such as may be opened 
in front and raised behind, a loose waist or dressing 
sack. Avoid draughts and cold. The patient should 
stand or sit with body erect and arms hanging evenly 
at the side. Careful inspection, which is the first 
method of examination following the verbal, will re- 
veal the general shape and symmetry of the chest, 
color, nutrition, size, the presence of tumors and 
abdominal bulging, or flattening of the chest wall. 

The front of the chest should be first examined ; for 
this purpose stand in front of the patient. Perfect 
symmetry is rare. Unusual development of the 



137 

muscles, unusual development of a viscus, occu- 
pation or spinal curvature are frequent causes 
of asymmetry. But marked malformations are not 
necessarily incompatible with healthy lungs and 
heart. The apex beat of the heart may or may not 
be seen. The undulatory movements of the chest 
should be the same on both sides, any marked varia- 
tions either in rhythm or depth from the normal would 
suggest disease. Inspection should not reveal any 
difference between the right and the left sides. There 
may be coloring of the skin, either natural or acquired; 
if the latter it may be pigmentation, as in diseases of 
the sympathetic nervous system, or in hepatic disturb- 
ances. There may be unusual color due to vasculari- 
zation, either a natural erythema, ruddy complexion, 
or the opposite. On the other hand there may be evi- 
dences of congestion, with eruptions as the result of 
arterial distension. From venous stasis may come 
ecchymosis and enlarged capillaries and superficial 
veins. Aside from this there may be either cyanosis, 
anaemia, pallor or general congestion. 

Detect any local bulging due to tumors or abscesses 
within the chest wall or to deformities of the bony 
structure. There may be asymmetry due to pressure 
from within, as hypertrophy of the heart, or the accu- 
mulation of gases or fluids within the pericardium, or 



138 



Enlargement. 



Osteopathic 
palpation. 



hydro- or pneumo-pericardium. The lungs may exert 
a pressure on the chest wall in tumors and swellings, 
and in pleuritic accumulations of gas or fluids. Even 
the thoracic form may be modified by the enlargement 
of abdominal organs due to fibroid growth, or to the 
accumulation of gases or fluids. 

In the pigeon breast from rachitis there is marked 
projection of the lower end of the sternum and a 
straightening of the ribs with a lessening of the trans- 
verse diameter. 

The alar or flat chest is accompanied by a narrow 
chest, acute costal angle, a flattening in the region of 
the dorsal spinal curve, winglike projecting scapulae, 
drooping shoulders, and neck set forward. These con- 
ditions are accompanied by weakness of constitution, 
and indicate imperfect expansion of the lungs, poor 
heart action and inability to resist disease. Such a 
patient is particularly liable to pulmonary tuberculosis. 

The lateral areas should be examined for tumors, 
pleuritic bulgings, etc. The posterior region should 
be carefully inspected for abnormalities, curvatures, 
straightening of spine, contractures of muscles, dis- 
placements, etc. 

The osteopath uses inspection just as the medical 
practitioner, and reasons from cause to effect through 
anatomical connections. When the osteopath palpates 



139 
he uses the name and changes the deed both in method 
and motive. Palpation to the old school meant the 
laying on of hands and trying to gain a knowledge of 
the internal condition by the sonant vibrations from 
the vocal chambers and from the transmitted move- 
ment of the apex of the heart. The osteopath uses his 
finger tips. With these he carefully explores the 
region of the spine determining if the spinous pro- 
cesses are prominent or retreating. He determines 
any deviation from the perpendicular line. His fingers 
tell him if the spines be separated, representing a point 
of weakness or a break. His trained fingers carefully 
examine the articulation of the tubercle of the rib 
with the transverse process and note any congestion, 
slip or thickening of the tissue here. 

Tenderness in any of these locations is the sign of a 
lesion, of the organs governed by that centre. This 
requires a careful differential diagnosis. Should there 
be a distinct anatomical disarrangement then a correc- 
tion of this condition will almost certainly remove the 
disturbance. Should it be a transferred or sympa- 
thetic tenderness, then the effect of treatment here 
may be transient or permanent. Even in acute cases, 
expect osseous lesion, there is always tenderness. 

To examine the heart there must be first an ability Sounds of the 

heart. 

to distinguish the normal sounds and the locations 



140 
at which they are best heard. This can be deter- 
mined by means of the ear unaided, but the stetho- 
scope or phonendoscope will aid in localizing and in 
analyzing the sound. The points at which you would 
apply the ear are as follows : 

For the aortic sound at the union of the second rib 
and its cartilage on the right side. For the pulmonary 
sound the corresponding position on the left side. 
The mitral is most advantageously heard at the point 
of the cardiac impulse in the fifth interspace. This 
sound is also heard in abnormal conditions between 
the vertebral margin of the scapula and the spine at 
the level of the fifth or sixth rib. This has the 
advantage of being entirely removed from the other 
heart sounds. It is important to remember that the 
mitral valve is affected more frequently than any other 
valve of the heart. Investigation of the tricuspid is 
best conducted at a point just below the end of the 
sternum in the soft wall, or else at the cartilages of 
the false ribs on the right side. 

The theory upon which the osteopath works in 
treatment of cardiac troubles is this : 
Theory of First. He affects the amount of work that the 

cardiac 

treatment. heart is doing through vaso-motors, increasing or 
decreasing it at will through peripheral resistance. 



141 

Second. Through augmentor fibres he increases or 
decreases the intensity of the impulses and thus 
directly affects the heart. 

Third. Through the inhibitory effect of the vagus 
he quiets an excited heart. 

Fourth. Through the general systemic effect of the 
vaso-motors and the cardiac augmentors he contributes 
to the general nutrition of the heart. 

Fifth. The motor nerves to the papillary muscles 
are from the upper dorsal, and by these any valvular 
weakness of an atonic nature may be removed. 

Sixth. The sensory fibres to the heart are from the 
upper dorsal region. Removal of any irritation to 
these will quiet any excited condition of the heart. 

Treatment is directed to all these sources. Tender- 
ness is usually marked at the angle of the fifth rib on 
the left side, also at the chondral articulation of this 
rib. Pressure at these two points at the same instant 
will produce a sensation as of some sharp instrument 
passing through the thorax. Examination of the ribs 
will show them to be rotated downward, bringing the 
inferior margin almost in contact with the superior 
margin of the rib next below. This results in 
tenderness of the intercostal nerves. The treatment 
which the osteopath administers depends upon the 
nature of the case. Any contracture of the 



142 
rhomboids, or the more deeply lying splenitis, 
semispinalis, multifidus spinse, transversalis colli, etc., 
must be removed, and in case of nervous affection this 
treatment, together with building up the nutrition of 
the body through the digestive organs, will prove 
sufficient. By elevating the ribs the capacity of the 
chest is increased, thus removing the pressure upon 
the pericardium. This frequently is done in cases 
in which the patient complains of a feeling of smother- 
ing and compression of the heart. 

Relaxing the muscles of the neck and pressure upon 
the middle and inferior cervical ganglia will reduce 
the rapidity of the heart-beat. 

Steady pressure on the solar plexus will quiet an 
over-exciting heart. 

In chronic heart trouble you will find costal or 
aSVeaimlnt vertebral lesions. Examine carefully the vertebra 
from the second to the fifth dorsal. To treat, relax by 
pressure the interscapular region, place patient on 
right side and pull upward and forward, pressing 
with right hand against angle of ribs. Another 
movement is to place patient on face and put sudden 
pressure on ribs at tubercle or transverse process. 
Have patient, sitting, lock his hands behind occiput. 
Standing at his back the operator passes his hands 
under patients arms and clasps them across back of 



143 

neck. Pulling downward on each side alternately 
will aid in overcoming an anterior condition. 

EXAMINATION OF THE LUNGS. 

To understand the location of the lungs it is 
necessary to be thoroughly conversant with the 
landmarks of the chest and with the location of 
certain lines. A perceptible ridge at the junction of 
the manubrium with the gladiolus, marks the level of 
the second cartilage. The nipple is between the 
fourth and fifth ribs just external to their cartilages. 

Thoracic 

The lower border of the pectoralis major corresponds Une *- 
with the fifth rib. The scapula covers the ribs from 
the second to the seventh. The end of the sternum is 
at the level of the tenth dorsal vertebra. The follow- 
ing lines are useful : 

The mesosternal, the middle line of the chest 
anteriorly. 

The sternal, following the margin of the sternum. 

The mammillary, parallel to the mesosternal, 
through the nipple. 

The parasternal, midway between the mammillary 
and sternal. 

The anterior axillary, a perpendicular line dropped 
from a point at which the pectoralis major leaves the 
thorax, the arm extended. 



Right lung. 



144 

The posterior axillary, a vertical line at the point 
where the latissimus dorsi leaves the chest, arm 
extended. 

The midaxillary line, midway between the anterior 
and the posterior axillary. 

The scapular line, vertical from the inferior angle of 
the scapula. 

The right lung extends about one and one-half 
inches above the first rib into the suprascapular region. 
It follows downward, reaching the mesosternal line at 
the second costal cartilage, following it to the sixth, 
thence it turns outward following the sixth rib to the 
mammillary line. It is at the eighth rib in the mid- 
axillary line and at the tenth rib in the scapular line. 
This lung has three lobes formed by the two fissures, 
long and short. The long fissure extends from above 
and behind obliquely downward and forward. It 
begins near the third dorsal vertebra and passes to the 
midaxillary line at the fourth rib and cuts the mam- 
millary line at the sixth. The short fissure begins 
near the anterior border of the scapula at the level of 
the third rib where it unites with the long, passes 
downward, inward and forward to the junction of the 
fourth costal cartilage with the sternum. Above this 
lies the upper lobe of the lung. 



145 

Between the third and the lower margin of the sixth 
rib is the middle lobe. The lower lobe is posterior to 
and below the long fissure. It reaches the thoracic 
wall in the lateral and subscapular region, but is 
absent in front. 

The left lung extends one inch higher into the neck 
than the right. It leaves the mesosternal line at the 
fourth costal cartilage, passes obliquely downward to 
the sixth rib in the mammillary line and between the 
eighth and ninth ribs at the midaxillary, and between 
the tenth and eleventh ribs in the scapular line. It 
has but one fissure which divides it into the upper and 
lower lobes. 

This fissure begins near the third vertebra, extends 
downward, forward and outward to the midaxillary 
line where it is at the level of the fourth rib. In the 
mammillary line it cuts the lower margin of the lung 
at the sixth rib. The upper lobe anteriorly occupies 
all above the sixth rib ; laterally, above the fourth rib, 
and posteriorly above the spine of the scapula. The 
lower lobe is absent anteriorly and lies below the upper 
lobe, posteriorly and laterally. 

In examination and treatment of the lungs it is nec- 
essary to keep their outlines in mind. Their space is 
easily encroached upon by any abnormality in the 
shape of the thoracic wall. 



Left lung. 



Treatment of 
lungs. 



146 

The pleura and lungs are supplied with sensory 
fibres from the spinal nerves coming from the first to 
the seventh, though Quain limits it to the upper five. 
The lungs are supplied by viscero-motor fibres from 
the vagus and by vaso-motor fibres from the upper 
dorsal, though some observers find these also to come 
from the vagus. But in either case they make their 
exit from the upper dorsal nerves. 

Our treatment for pulmonary or bronchial trouble is 
as follows : Contractures, in the upper spinal regions, 
are reduced, the ribs are elevated by pressing against 
their tubercles and pulling the arm upward and back- 
ward. The patient lying on his back the hands are 
drawn up over the head, the patient inhaling deeply, 
then are pushed downward as he exhales. Another 
treatment is to place the patient on a stool ; placing 
your knee between his shoulders grasp the arms near 
the elbows, pull upward and slightly backward, the 
patient breathing as before. 

In bronchial troubles pay particular attention to the 
anterior portion of the chest, placing two fingers be- 
tween the ribs parallel to them, then turn and press 
upward and outward at the same time. This relaxes 
the intercostal muscles and removes irritation to the 
sensory nerves. 



CHAPTER VIII 



ABDOMEN AND PELVIS. 

\ S THE divisions of the abdomen with their 
■*■ -*- contents may be found in all works on 
anatomy it will be omitted here. 

The linea alba, or central abdominal line, extends 
from the ensiform cartilage to the symphysis pubis. 

The rectus muscle is crossed by three tendinous 
intersections which divide it into three portions. 
These sometimes cause mistakes in diagnosis, as a 
spasmodic contraction of one of these, or a collection 
of fluid within the sheath is taken for disease of the 
abdominal organs. The lowest is at the level of the 
umbilicus, the next at the level of the lower portion of 
the tenth rib and the highest at the ensiform cartilage. 

The umbilicus is the most prominent landmark of 
the abdomen, lying in the middle line, nearer to the 
pubes than to the ensiform. It is usually at the level 
rJ the disc above the third lumbar vertebra. 



148 

About one and one-half inches below the umbilicus 
at the level of the highest part of the iliac crest is the 
bifurcation of the aorta into the two common iliac. 
Here is the hypogastric plexus. 

The anterior superior spine of the iliac is of great 
importance to the osteopath since it is taken as a fixed 
point in determining the length of the limb or nature 
of pelvic or hip troubles. This point is of importance 
in diagnosing femoral dislocations. The thumbs 
placed on either spine and the fingers grasping the 
trochanters will easily enable you to appreciate any 
difference in the relation of the two sides. 

The pubic spine is of importance in deciding the 
nature of hernia ; the spine is on the outer side of an 
inguinal hernia ; on the inner side of a femoral. 

laying one or one and one-quarter inches external to 
the spine of the pubes on the line connecting it with 
the trochanter major is the femoral ring which is the 
upper end of the femoral canal. On account of the 
relation of the internal saphenous vein and the 
femoral artery and vein this canal is of much 
importance. 

Just above and slightly external to the spine of the 
pubes is the external abdominal ring. The inguinal 
canal, of which the external abdominal ring is the 
inferior opening, extends obliquely downward and 



149 
inward almost two inches fiom the internal abdominal Externa 

abdominal 

ring, about midway between the anterior superior nn °' 
iliac spine and the symphysis, more than half an inch 
above Poupart's ligament. The external ring 
transmits the round ligament in the female and the 
spermatic cord in the male, two very important 
structures in osteopathic practice. It is well to 
emphasize a caution before given, that the operator be 
careful to use the finger tips carefully to avoid injury 
or irritation. 

Lying chiefly within the hypochondrium, sheltered 
by the ribs and cartilages is the liver — the largest 
gland in the body. It extends above the colon, 
stomach and duodenum, from the right hypochon- 
drium across the epigastric region into the left 
hypochondrium, as far as the mammillary line. 

The liver is from six to eight inches long, weighing Theiiver. 
not far from five pounds, varying with the individual, 
and in the same individual at different times. Its 
relation to the digestive and circulatory systems is a 
peculiar one. It receives an abundant blood supply 
and performs important changes on the partly assimi- 
lated food stuffs. Its highest point is on the right 
side, extending upward to within an inch of the 
nipple, or on the right side at the mammillary line it 
arises to the upper border of the fifth interspace. 



150 
The liver on the right side is covered by the ribs 
from the sixth to the eleventh inclusive. On the left 
it lies beneath the cartilages of the sixth and seventh 
ribs, its lower margin across the epigastrium lying 
across the stomach corresponding to a line drawn 
from the ead of the ninth rib on the right to the 
junction of the seventh on the left. At the point 
where the liver crosses linea alba, half way from the 
ensiform to the umbilicus, the edge is easily felt. 

Constriction of the thorax and abdomen by stays 
may result in displacement of the liver downward. 
Here the liver lies in direct contact with the abdominal 
wall. In precussion for liver dullness it must be 
remembered that superiorly it is covered by lung, that 
the phrenic sinus due to the arching upward of the 
diaphragm is next, while the region of absolute liver 
dullness is below the diaphragm. In the gastric fossa 
sometimes loops of distended intestine lie anterior to 
it, resulting in a tympanitic note. Its nutrient blood 
is from the hepatic artery, a branch of the cceliac axis, 
while its functional blood, much increased during 
digestion, comes from the mesenteric veins, the gastric 
and the splenic. 
Functions of Its secretion is double, an internal contribution to 

liver. 

the blood, glycogen and urea ; an external, from the 
gall cyst or directly from the liver into the digestive 



151 
tract. Bile is a utilized waste product, as by its pres- 
ence in the intestines it increases functional activity of 
the tract and aids in absorption of fats. The urea 
which it throws into the blood stream is an end prod- 
uct of nitrogenous katabolism. Glycogen is a carbo- 
hydrate which is essential as a force former ; the pig- 
ments and acids of the bile when not thrown into the 
sewage of the body act as harmful substances within 
the blood, affecting the nerve centers, thus retarding 
metabolism. Any impairment of the functions of the 
liver will result in the retention within the blood of the 
antecedent substances from which the urea is formed. 
This substance, carbonate of ammonia, acts as a pow- 
erful poison to the nervous system ; hence the nervous 
disturbances that usually attend hepatic lesions. 

Its nerve supply is from several sources ; the left 
pneumogastric contributing fibres directly to the liver 
from its distribution over the lesser curvature of the 
stomach. The solar plexus through the cceliac plexus 
sends fibres along the hepatic artery. These fibres are 
from three sources, the right pneumogastric, the 
splanchnics and the phrenics. The phrenics are dis- 
tributed to the capsule and to the superior portion of 
the liver. The splanchnics are the vaso-constrictors. 
The vagi furnish vaso-dilator fibres and most likely 



152 

secretory fibres, though the existence of the latter has 
never been definitely proven. 
where treated. The center for the liver is rather a diffuse one, 
though it is definitely located between the ninth and 
tenth on the right side. The connection with this seg- 
ment is to be found in the splanchnics. Again, the 
liver may be reached through the solar plexus directly, 
or along the course of the hepatic artery. This may 
be reached one and one-half inches above the umbili- 
cus and about the same distance to the right of the 
middle line. Always examine the seventh to the tenth 
ribs inclusive as they may by pressure cause trouble 
with this organ. 

The gall bladder is normally covered by liver sub- 
stance lying inferior to the fossa vesicalic at the margin 
of the quadrate lobe, the fundus alone extending from 
beneath its glandular covering, emerging from its 
chondral protection just at the level of the ninth car- 
tilage. Under normal conditions the gall bladder can- 
not be felt, though it may be if distended. It is just 
external to the right rectus muscle. 

Since all the blood passing through the cceliac axis 
and some from the inferior mesenteric artery passes 
through the portal system, it is clearly seen that the 
liver is influenced by the condition of the circulation, 
and also that any failure of the liver to function would 



153 
result in leaving in the blood substances whose effects 
are those of poisons. 

Our treatment of the liver which has for its object 
the restoration of function through its nerve and blood 
supply is as follows : 

First. Treatment to relieve any congestion or sub- 
luxation in the liver area, the ninth and tenth dorsal. 

Second. Local effects through the solar plexus 
or branches from it. 

Third. A stimulation of the pneumogastric. 

Fourth. By vibrating the thoracic walls over the 
liver with the heel of the hand, thus physically caus- 
ing a change in its circulation and supplying its cells 
with pure blood. 

For sluggishness of the liver resulting in torpidity 
of bowel, the gall cyst is induced to empty its contents 
into the duodenum by pressure on the fundus. To 
accomplish this the hand is placed on the abdominal 
wall at the ninth rib, just external to the rectus. The 
legs are flexed upon the abdomen, the patient lying 
either on the back or on the left side. The patient is 
instructed to take a deep inspiration and then as the 
breath is sent out the hand follows the retreating wall 
and pressure is thus put on the fundus. This is not a 
mechanical emptying but a stimulus applied directly 
to the fundus, resulting in a peristalsis. 



154 
Failure of the liver to function may cause icterus, 
nervousness, skin eruptions, sleeplessness, drowsiness, 
constipation, haemorrhoids, etc. 

Spleen. ^^ e spleen is a much less important organ than the 

liver, both in size and in function. It lies, as we said, 
at the level of the tenth rib. Its upper margin is on a 
level with the ninth dorsal spine, its lower with the 
eleventh. It lies in the infraaxillary space, extending 
from the anterior axillary line to the posterior. Cov- 
ered with the chest wall, it cannot be felt, save in case 
of enlargement. For examination the operator must 
rely on percussion, save in enlargement. In all infec- 
tious and malarial diseases the spleen is affected and 
should have proper care. The general circulation 
must be maintained. The ninth and tenth dorsal on 
the left side will reach the spleen through the sym- 
pathetic. The right vagus also contributes to this 
organ. 

stomach, ^^ e siomac ^ li es in the upper abdominal region ex- 

tending from the left hypochondrium across the epi- 
gastrium to the edge of the right hypochondrium. 
This places about one-sixth to the right of the median 
line, five-sixths to the left. The cardiac opening lies 
just to the left of the middle line opposite the seventh 
chondro-sternal articulation. The fundus extends up 



155 
as high as the sixth interspace and emerges from the 
hypochondrium at the end of the ninth rib. 

In the median line in moderate distention the lower 
edge of the stomach extends about an inch lower than 
the liver, one and one-half inches above the umbilicus. 
Arching upward and to the right the pylorus is situ- 
ated beneath and behind the liver opposite the first 
lumbar vertebra and back of the end of the eighth rib. 
Under normal conditions the pylorus cannot be felt. 

The fundus lies in the left hypochondrium and ex- 
tends to the cupola of the diaphragm. Distention may 
seriously encroach upon the thoracic space, leading to 
palpitation and irregularity of heart action, and short- 
ness of breath. This must be examined in functional 
disturbances of the heart. 

The stomach is covered anteriorly by the diaphragm 
and the thoracic wall formed by portions of the sixth, 
seventh, eighth and ninth ribs, the left and quadrate 
lobes of the liver and the abdominal wall. It lies an- 
terior to the abdominal aorta and vena cava and the 
cceliac axis. It is in relation with the left kidney, the 
spleen and its vessels, the pancreas, the colon and part 
of the duodenum. Back of the stomach lies the solar 
plexus which, to the osteopath, is its most important 
relation. 



156 

Blood and The stomach has a liberal blood supply ; from the 

nerve supply. 

coeliac axis, the gastric; from the hepatic, the pyloric; 
from the gastro-duodenalis, branch of the hepatic, the 
gastro-epiploica dextra ; from the splenic, the vasa 
brevia and the gastro-epiploica sinistra. Thus the en- 
tire blood supply is from the coeliac axis through its 
subdivisions and their branches. 

With the blood vessels the stomach receives inner- 
vation from the solar plexus, fibres coming from the 
splanchnic and from the right pneumogastric. In ad- 
dition the stomach receives fibres directly from both 
the right and left vagi. These fibres from the vagi 
enter into the structure of the walls of the stomach 
and are supposed to end within the fibres of the 
muscles. Experiments upon animals show the vagi to 
be the nerves of motion to the stomach, stimulation of 
its peripheral portion after section resulting in in- 
creased movement. But the fact of section of both 
vagi does not mean a cessation of motion, for the 
stomach will manifest normal movements after all ner- 
vous connections have been severed. It may be that 
the stomach has the power of originating motion, — a 
property derived perhaps from the plexuses of Auer- 
bach within the walls. The solar plexus contributes 
chiefly vaso- constrictors from the splanchnics, though 
vaso-dilators also are found. The splanchnics entering 



157 

into the coeliac plexus also carry secretory, inhibitory, 
and sensory fibres. These splanchnic fibres are from 
the fourth to the eighth dorsal in orgin, though we 
get our surest effect at the fourth to sixth dorsal verte- 
bra, more accurately between the fourth and fifth. 

The duodenum begins at the level of the first lum- ^JiJ 
bar vertebra on the right side, lying beneath the carti- 
lages of the false ribs at the level of the sixth inter- 
space. It curves upward, backward and to the right. 
It is in close relation with the liver and gall cyst 
superiorly. Above and posterior to it run the hepatic 
artery, portal vein and bile duct. It now descends 
over the vena cava ascendens and the right kidney to 
the level of the fourth lumbar vertebra. It here 
ascends obliquely upward across the third and fourth 
lumbar vertebrae, crossing the vena cava and aorta to 
its ascending portion lying beside the aorta and the 
fourth, third and second lumbar vertebrae. The head 
of the pancreas lies within the concavity of the arch, 
while the body lies above the transverse and ascending 
portions. The terminal portion of the duodenum lies 
behind the stomach to the left of the superior mesen- 
teric vessels, and just at the inner side of the left 
kidney. This now marks the beginning of the second 
portion of the small intestine, the jejunum, which 
continues for the next two-fifths of the length of the 



158 
small intestine, the remaining portion being called the 
ileum. 

The small intestine as a whole lies within the 
middle zone of the abdomen, the mesogastric, practi- 
tically filling the umbilical region, lying anterior to 
the ascending colon in the right lumbar and bearing 
the same relation in the left lumbar to the descending. 
The small intestine will or will not lie in the pubic 
region according as the bladder is empty or distended. 
Location and The mesentery, to which so much of the blood of 

Treatment of 

Mesentery. ^ e mesen teric artery is sent, lies almost exclusively in 
the umbilical region. Gentle movement and pressure 
here will quiet pain in the small intestine. 

In the right iliac region lies the caecum and the 
point of union of the caecum and the ileum. Begin- 
ning at this point is the large intestine, the ascending 
portion passing up through the right lumbar to the 
inferior surface of the liver, thence across the abdo- 
men on a line separating the umbilical and epigastric 
regions, as the transverse colon. It lies above the 
umbilicus in this region and in front of the duodenum 
next to the anterior abdominal wall. The descending 
colon extends from the splenic flexure in the 
left hypochondrium downward for eight inches to 
the iliac crest, at which point begins the sigmoid or 
omega loop. 



159 

The kidneys lie on either side of the vertebral 
column, anterior to the transverse processes, extending 
from the upper margin of the twelfth dorsal vertebra 
to the upper part of the third lumbar. Covered later- 
ally by the twelfth rib and by the quadratus lum- 
borum and psoas muscles, palpation will reveal but 
little as to their condition. Tenderness, muscular con- 
traction, vertebral and costal dislocations are the 
leading symptoms to the osteopath. Urinary exam- 
ination must also be made. 

Above the kidney on the left side is the spleen, on 
the right the liver. The nerves to the kidney come 
through the solar plexus and chiefly from the least 
splanchnic nerve. Some fibres are derived from the 
aortic plexus. Vaso-constrictor and sensory fibres 
to the kidney are from the eleventh dorsal to the 
first lumbar inclusive. 

To treat the kidneys the patient is placed on side, 
facing operator, the knees and thighs are flexed and 
strong pressure is applied to the lower dorsal and 
upper lumbar regions, the spine being strongly moved 
backward and forward at the same time. 

Another treatment is strong and steady pressure at 
this point, the patient lying on his face. 

Again, the patient lies on his back with legs drawn 
up. The operator puts hands beneath him, palms 



160 



The Pelvis. 



External 

Abdominal 

Ring. 



upward. Now, with the patient lying on finger tips, 
the operator repeatedly raises him, relaxing the 
muscles, at the same time rotating the legs and moving 
them from side to side. 

The massive bony basin which lies beneath the 
abdomen has for its structure four bones compactly 
put together, the sacrum, the ilium, the ischium and 
the pubes. This constitutes the pelvis. 

The plane passing through the upper margin of 
the symphysis, linea ilio-pectinea and the sacral promi- 
nence divides this basin into two portions ; the part 
above, the false pelvis, and the part below, the true 
pelvis. The false pelvis is in position and function a 
portion of the abdominal cavity, serving to hold the 
weight of the intestines from the pelvic organs. The 
anterior boundary is between the widely separated iliac 
spines closed by abdominal parieties. 

This region, which is really a portion of the hypo- 
gastrium, is bounded laterally by the ossa ilii and 
contains part of the intestine ; the bladder in 
distention, and the uterus in pregnancy, extend up 
into this region. 

Opening through the abdominal or pelvic wall, 
just above and to the outer side of the crest of the os 
pubis, is a hiatus in the external oblique muscle called 
the external abdominal ring. This opening lies above 



161 

and internal to Poupart's ligament at its insertion into 
the pubic spine, extending about an inch upward and 
outward from a point between the spine and sym- 
physis. This opening transmits the spermatic cord or 
the round ligament, according to sex. 

The points of importance to the osteopath are 
these : An inch lateral to the lumbo-sacral articula- 
tion just above, and median to the posterior superior 
spine is the posterior sacro-iliac ligament. The 
lumbo-sacral articulation is itself one of the 
weak portions of the spine. Here, in case of slip, strain 
or dislocation, will be found marked tenderness. One 
and one-half inches below and three-fourths of an inch 
lateral to this point is the lower and posterior portion 
of auricular articulation, below the posterior superior 
spine. Tenderness here is indicative of a slip of the 
ilium upon the sacrum. An inch below this is the 
great sacro-sciatic notch, lying under the posterior 
inferior spine of the ilium. About two inches below 
the inferior iliac spine is the ischiatic spine, which 
with the lesser sciatic ligament attached to it converts 
the greater sciatic notch into a foramen and separates 
it from the lesser notch below. 

The pyriformis muscle passes through the greater p yr iformis 

Muscle. 

notch and attaches to the great trochanter. This is a 
very important structure. Above this muscle pass 



162 
out the gluteal artery and vein and the superior glu- 
teal nerve ; through this notch, below the muscle, pass 
the two sciatic nerves, the sciatic vessels, the internal 
pudic vessels and the pudic nerve. The pudic nerve 
passes over the spine and re-enters the pelvis through 
the lesser notch. This nerve is distributed to the 
penis or clitoris, to the rectum and to the perinseum. 

The pyriformis, the gemelli, the obturator and 
the quadratus femoris muscles may all be relaxed by 
internal rotation of the thigh, accompanied by pressure. 
This will be useful in rheumatism of the muscles of the 
hip, in sciatica and in vaso-motor or circulatory dis- 
turbances in the limb. 

The ischiatic tuberosity is to the side of the anal 
opening and can be plainly felt. Half way between 
this point and the trochanter major the great sciatic 
nerve may be compressed. 

The coccyx can always be felt just above the anus. 
It is important that it be in correct position as it is 
frequently the cause of constipation, coccygodynia, etc. 
It can be best examined per rectum. 

The anterior bony prominence is the pubic spine 
nearly an inch lateral to the symphysis. It should 
not be sensitive to pressure, but if there be a slip of the 
ilium on the sacrum there will be marked tenderness 



163 
at symphysis. Also one side will be elevated or 
depressed as the case may be. 

The ischio-rectal fossa lies between the anus and the li c il ~ rectal 
tuberosity of the ischium. In this the osteopath reaches 
the levator ani, sphincter ani, the coccygeus muscles, 
fascia covering important structures, the walls of the 
rectum, the posterior wall of the vagina, the pudic 
nerve and vessels and their branches. 

The ischio-rectal fossa is also treated by insertion 
of the finger into the rectum. Here, too, may be 
treated the prostate gland and the membranous 
urethra. The lower and upper sphincters may be 
reached and dilated and a stimulation applied to the 
rectal wall. Treatment per rectum should not be 
given more often than once per week, except in rare 
cases. Rectal examination will reveal much as to the 
position of the uterus. Vaginal examination will 
detect the urethra along its anterior wall, the rami of 
the pubes and ischia. The ovary cannot be felt either 
per vagina or through the pubic region unless pro- 
lapsed or enlarged. They lie two inches on either 
side of the middle line of the body and about the same 
distance above the pubic crest. 



CHAPTER IX. 



THE LIMBS. 



THE shoulder is to the osteopath an important 
articulation . The arm is used in many of the 
movements which the operator administers. Owing 
to the multiform uses of the arm and hand, the shoulder 
is called into actions varied and constant, so that 
strains and dislocations are of frequent occurrence, 
while the massive musculature is prone to deposit the 
product of destructive metabolism within the tissues 
which go to perfect its motion. From strains, colds 
and rheumatism, the shoulder suffers more often than 
any other joint. 

The clavicle extends in an almost horizontal position 

from the manubrium sterni to the acromion process 

Landmarks where usually the acromio-clavicular joint forms an 

Oj~ SflOXllCLCV, 

almost even plane, but there may be a noticeable 
enlargement of the acromial end of the clavicle or an 
increase of the fibro-cartilage in the joint. This 



165 
prominence is often mistaken for a dislocation or for a 
clavicular fracture. On the other hand a dislocation 
is often mistaken for this projection. When in doubt 
compare carefully with other shoulder. The three 
chief landmarks are, (i) the union of the scapular 
spine with the acromion process, a fixed point from 
which to measure the relative lengths of the arms ; (2) 
the coracoid process about two inches anterior to this, 
and (3) the greater and lesser tuberosities of the 
humerus. 

The greater tuberosity faces in the direction of the 
external condyle ; the lesser in the normal position 
of the arm lying somewhat in front and toward the 
median line of the body. The bicipital grove may be 
felt on deep pressure lying between the tuberosities, 
extending downward marking the direction of the 
biceps muscle. The head of the humerus can be felt 
above the axillary space. If low in the axillary 
space, or below and in front of the coracoid process, or 
behind on the back of the scapula below the acromion, 
it is dislocated. Great care must be used in diagnos- 
ing a dislocation as sometimes a fracture may be 
overlooked. Crepitation, freedom of movement and 
holding the head of the humerus while the arm is 
moved will aid in differentiating between these con- 
ditions. 



Muscles of 
shoulder. 



166 

The clavicle is attached to both the sternum and the 
cartilage of the first rib by ligaments which allow of 
motion, though limited, in all directions, and is the cen- 
ter of all movements of the shoulder. It passes high 
above and internal and posterior to the coracoid process, 
to which it is bound by the coraco-clavicular ligament. 
The clavicle is firmly bound to the acromion, yet in 
such a way as to permit either bone to move on the 
other, the clavicle gliding, the scapula rotating on the 
clavicle. This articulation sometimes becomes the 
seat of acute pains which manifest themselves in eleva- 
tion of the shoulder. This joint is supplied by the 
suprascapular nerve. The nerves to the shoulder 
joint are the suprascapular and the circumflex, from 
the brachial plexus. 

The muscles which connect the arm with the trunk, 
with which the osteopath is most especially concerned, 
are the following : The pectorales major and minor 
and the subclavius which are useful in ordinary 
movements of the arm and shoulder, yet their use is 
much magnified by the osteopathic practitioner. 
These three muscles all attach to the ribs, the 
subclavius to the first, the pectoralis minor to the 
third, fourth and fifth, while the major embraces the 
clavicle, sternum and cartilages of the ribs to the 
seventh, thus giving the ideal leverage on the ribs for 



167 
drawing them up and expanding the chest. In case 
any of the first six or seven ribs are deflected these 
muscles are used in replacing them, by drawing the 
arm upward, outward and backward, pressing at the 
same time on the angle of the ribs. The nerves of 
the pectoral muscles pass inward, the external crossing 
the axillary artery, the internal lying between it and 
the vein and both passing across the pectoralis minor ; 
the external piercing the costo-coracoid membrane, 
thence between the muscles and thus lying by its 
branches both below and above the pectoralis minor. 

The blood supply to the pectoral region is from the 
superior thoracic, thoracic branch of the acromial 
thoracic and the long thoracic together with the 
subscapular. These are all branches from the axillary 
artery and may be reached in the axillary space 
beneath the pectoralis muscle. 

The costo-coracoid membrane covers the space „ . 

r Costo -coracoid 

infinity at) p 

between the clavicle above ; the pectoralis minor below, 
the coracoid process externally and the first rib 
internally ; these points being its attachments. The 
anterior thoracic nerves may both be reached here as 
may the acromial thoracic, the superior thoracic 
vessels and the cephalic vein. The last is useful in 
drainage of the arm. 



The deltoid 
muscle. 



168 

The deltoid muscle raises the arm at right angles 
laterally to the trunk and together with the teres 
minor receives the circumflex nerve. The teres minor 
can be reached in the posterior scapular region, 
extending from the scapula to the lowest facet of 
the humerus. This muscle rotates the humerus out- 
ward and with the major and the supraspinatus pro- 
tects the joint from anterior dislocation. 

The circumflex nerve which supplies the deltoid and 
the teres minor is distributed to the joint and to the 
skin covering it. It crosses the quadrilateral space 
formed by the long head of the triceps internally, the 
neck of the humerus externally, the teres minor above 
and the major below. Here it may be reached either 
anteriorly or posteriorly. The branches are upper and 
lower, the lower may be reached at the posterior 
margin of the deltoid, the upper at the anterior. This 
nerve is frequently involved in case of trouble at the 
shoulder. 

The two spinati muscles which insert into the upper 
and middle facets of the humeral head, act with the 
deltoid and the teres minor. The supraspinatus in 
elevating the arm, the infraspinatus in rotating the 
humerus outward. The suprascapular nerve coming 
from the fifth and sixth cervical supply those muscles, 
while it also distributes branches to the shoulder and 



169 
to the claviculo-acromial articulation. This nerve 
enters the supraspinatus fossa at the suprascapular 
notch and crossing the fossa passes beneath the 
acromial end of the spine to the infraspinatus muscle. 
It may be reached either at its origin or as it crosses 
the fossa beneath the trapezius and the supraspinatus 
muscles. 

The subscapularis muscle passes from the ventral 
surface of the scapula and serves as a guard against 
anterior dislocation of the humerus by inserting into 
the lesser tuberosity. Its nerve supply is in common 
with the teres major and the latissimus dorsi, derived 
from the subscapular nerves. These nerves come 
from the fifth to the eight cervical and may be reached 
at their origin or at the posterior border of the axilla. 

By means of the arm and shoulder the osteopath 
obtains leverage upon the entire vertebral column. Levera o e - 
Through the latissimus dorsi on the lower dorsal and 
lumbar, through the teres and subscapularies by the 
rhomboids he puts stress upon the upper dorsal. The 
levator anguli scapula connects the shoulder with the 
cervical region. 

The rhomboids are innervated from the fourth and 
fifth, or from the trunk of the fifth just before the 
cord is formed ; the levator anguli scapulae gets the 
third cervical. 



170 
The important muscles of the shoulder joint are the 
biceps, coraco-brachialis and triceps. The inner mar- 
gin of the coraco-brachialis lying almost parallel with 
the axillary artery. The long head of the biceps lies 
in the bicipital groove, is attached to the supra-glenoid 
tubercle and is thus closely related to the joint, being 
easily involved in troubles of the shoulder. Its loca- 
tion may be determined by the two tuberosities be- 
tween which it lies. The median nerve and the 
brachial artery lie along the inner margin of the coraco- 
brachialis and the biceps, the median lying first exter- 
nal and then crossing the artery in its middle course. 
The ulnar nerve lies about an inch internal to the 
median, almost parallel to it, leaving it at the elbow ; 
the median at first passing beneath the bicipital fascia 
to the middle of the forearm. The basilic vein lies 
between the artery and the ulnar nerve, a fact to be 
remembered as this vein is useful in drainage. 

Landmarks The elbow is the seat of much trouble, lack of mo- 

of elbow. 

tion, displacement, etc. The outer and inner condyles 
are easily located, while the olecranon process of the 
ulna comes on a level with those two points when the 
arm is extended. Place the thumb on one condyle, 
the middle finger on the other and the index finger on 
the olecranon, Ulnar dislocation would destroy these 
relations. The olecranon is nearer the inner than the 



171 

outer condyle. Between the olecranon and the inner 
condyle is a depression which conveys the ulnar nerve 
— the funny bone of the laity. External to the olec- 
ranon is a well marked depression lying just below 
the external condyle. This is one of the most im- 
portant landmarks, since deep within it, external to 
the supinator longus and the extensor carpi radialis 
may be felt the head of the radius moving in pronation 
and supination. This is a guide in determining dislo- 
cation of the radius. The lymphatics of the elbow 
usually are the first to manifest excitation if poisons 
are absorbed through wounds of the hand, — a small 
gland just above the internal condyle usually first 
showing this condition. The musculo-spiral nerve 
winds around the arm and becomes anterior above the 
external condyle. 

The simplicity of structure of the arm makes this a 
very easily studied articulation. The biceps, the 
brachialis anticus and the supinator longus are the 
chief muscles of flexion of the forearm. The triceps 
is the chief extensor, the anconeus which may be con- 
sidered as a portion of the triceps, assisting. The two 
supinators are innervated by or from the musculo- 
spiral, the pronators by the musculocutaneous. 

The usual dislocation at the elbow is one or both 
bones backward or else both forward ; the former when 



172 

the forearm is extended, the latter when flexed, lat- 
eral displacement is rare. The usual method of reduc- 
ing such dislocation is by a direct pull, the knee may- 
be placed at the bend of the elbow, and straightening 
the arm, at the same time exercising great force so as 
to overcome the dislocation. 
The wrist. The wrist is frequently the seat of synovitis arising 

from rheumatic troubles or from pyaemia. Distention 
of the synovial sack causes fullness over the back of 
the wrist. The styloid processes are the guides to the 
wrist, that of the radius extending downward farther 
than the ulna. There is a bony furrow on the back 
part of the radius which transmits the tendon of the 
extensor longus pollicis muscle. This is the place of 
examination in case of Colles fracture of the radius. 
In case of radial fracture the styloid process of the 
radius will be on a level with or above the styloid of 
the ulna. The scaphoid tubercle may be distinguished 
just below the radius, the articulation of these bones 
lying between these points. The trapezium lies just 
below and articulates with the metacarpal of the 
thumb. The pisiform bone may be felt just below the 
ulnar styloid, the unciform lying within. The tendons 
of the wrist are important. The extensors may be 
traced, using each alternately, the three extensors of 
the thumb lying on the outer side of the wrist. The 



173 

flexor carpi radialis tendon is a guide to the radial 
artery. 

The hip is related to many important structures 
which bear upon the physiology of the limb. You will 
recall some points referred to in the preceding chapter, 
namely, the symphysis pubes and the spine of the 
pubes which lies external to the symphysis on the 
same level as the upper part of the trochanter major 
About one and one-half inches external to this is the SaphmoU8 
saphenous opening, a point at which a femoral 
hernia first makes its appearance. The point is just 
below Poupart's ligament. Its chief importance to the 
osteopath lies in its relation to the drainage of the leg 
The femoral ring is half an inch higher than the 
saphenous opening. Find the pulsation of the iliac 
artery, pass toward the median line one-half inch 
from the iliac vein and next is the femoral opening or 
ring. The anterior superior spine of the ilium is an- 
other point of interest as being the fixed point of meas- 
urement in case of suspected dislocation. 

The trochanter major is a prominence which cannot 
be missed. It is covered by the skin and by the fascia 
of the gluteus maximus. The head of the femuris 
about three-fourths of an inch above the level of the 
pubic spine, in all positions looking in the direction of 
the inner condyle. Great care is necessary in diag- 



174 
nosis of femoral dislocations. The osteopath must 
bear in mind the fact that even partial or complete dis- 
location may be the result of tubercular processes. 
Motion in such cases is a positive injury, though treat- 
ment may be effective if directed toward the blood and 
nerve supply. In dislocation the ilio-femoral liga- 
ment, the most resistant portion of the capsular, 
determines largely the position of the hip. 
Test for To detect dislocation the patient should be lying 

dislocated hip. 

straight, face upward ; place the thumbs on the 
anterior superior spines of the ilia. A comparison of 
the two sides is usually the surest way of determining 
relative positions of the parts. Nelaton's line is use- 
ful. It is a line from the anterior superior spine to 
the tuberosity ischii. On this line lies the center of 
the acetabulum and at the same level as the trochanter 
major. The femur may be dislocated in any direction; 
backward, either above the dorsum ilii, or below the 
obturator internus muscle into the sacro-sciatic notch, 
or it may be anterior on the pubes or inferior into the 
obturator or thyroid foramen. 

The chief muscles which serve as landmarks around 
the hip are the glutei, the sartorius and the adductor 
longus. Raising the leg will throw the sartorius and 
adductor longus into relief, thus outlining Scarpa's 
triangle. 



175 

Between the ischiatic tuberosity and the greater 
trochanter may be reached the sciatic nerve, lying 
close to the femur. It may be followed down the 
thigh, where it divides into popliteal branches above 
the popliteal space. This nerve supplies the hamstring 
muscles, the adductor magnus and some branches to 
the hip joint, while some fibres from both its popliteal 
branches are distributed to the knee. 

The obturator nerve may be reached just below the obturator 

nerve. 

pyriformis internal to the sciatic. This nerve supplies 
the acetabulum and also the teres ligament and in 
common with the sciatic and the anterior crural nerve 
is distributed to the knee on its inner side. It is one 
of the three nerves affected when trouble at the hip is 
indicated by pain at the knee. The adductors and 
gracilis are innervated by this nerve. 

The femoral artery which supplies the thigh and leg 
may be followed to the knee by a line drawn from the 
middle of Poupart's ligament to the adductor tubercle 
on the inner condyle. 

The patella can be felt on the anterior of any knee, 
its tendon lying in a vertical plane. This tendon, a 
continuation of the extensor tendons of the leg, lies in 
the line continued through the tubercle of the tibia, 
drawn from the middle point of the ankle. The 
synovial sac lies beneath the patellar ligament one- 



176 

half its length, while it rises above the patella two 

inches, slightly higher beneath the vastus intern us 

than the vastus externus. 

The condyles of the femur and the tubercle of the 

tibia to which the ligamentum patella is attached are 

prominent points. The head of the fibula lies at the 

level of the insertion of the patellar ligament, on the 

outer side, the tubercle of the tibia on the inner side. 

Ligaments ^e ligamentous structures of the knee are compli- 

ed the knee. .. , , . , 4 , . ,_. , . , , 

cated and liable to injury. The external are the only 
ones which are palpable and their positions should be 
remembered. 

The patella has been mentioned. The posterior 
extends across the floor of the popliteal space. The 
internal reaches from the tuberosity on the inner con- 
dyle of the femur to that of the tibia, being crossed 
by the inner hamstrings ; the short external extends 
behind the external from the condyle to the styloid 
process of the fibula. Beneath the external lateral 
ligaments pass the external articulate vessels and 
nerves. 

The nerves are from the external and internal popli- 
teal branches of the sciatic, from the anterior crural 
and the obturator. 

Its vascular supply is abundant and may be utilized 
in case of effusion around the joint. The tendons of 



177 

muscle around the joint are : The quadratus femoris, 
anteriorly ; internally and posteriorly, sartorius, 
gracilis, semi-membranosus and semi-tendinosus which 
are inserted into the inner aspect of the tibia. 

The biceps tendon is related to the external lateral 
ligament and is attached to both tibia and fibula, the 
ilio-tibial band passing anterior to it to be inserted 
into the head of the tibia. The popliteal space offers 
the point for effecting both superficial and deep drain- 
age of knee and leg through the popliteal and short 
saphenous veins. Rocking of the knee in extension is 
due oftentimes to shortening of these cords, sometimes 
due to misplacement of the semilunar fibro-cartilages 
of the knee. 

The two prominent landmarks of the ankle are the Landmarks of 

the ankle. 

two malleoli, the inner longer and lower than the 
outer. Back of the inner malleolus may be reached 
the posterior tibial nerve, a continuation of the 
internal popliteal, the posterior tibial artery and the 
short saphenous vein. 

The anterior tibial artery and nerve lie between the 
tibia and the fibula anteriorly, passing beneath the 
annular ligament between the tendons of the flexor 
proprius hallucis internally and the flexor longus 
digitorum. 



178 

The tendons around the ankle are : The tendo- 
achillis prominent behind ; external to this the two 
peroneii, while internal to it behind the inner malleolus 
we find tendons of the tibialis posticus, flexor longus 
digitorum and the flexor longus hallucis. On the 
front of the ankle are the four tendons which extend 
to the foot and the toes. The sciatic nerve innervates 
all the muscles of the leg and the foot through its 
branches or sub-branches. 

The popliteal artery divides into the anterior and 
the posterior tibial an inch and a half below the 
popliteal space, the anterior passing between the bones 
anteriorly and the posterior continuing down the 
middle line of the leg. 

In rheumatic affections of the knee or the ankle or 
in strains of these articulations the nerves must be 
carefully treated. The drainage must be watched in 
all cases in which effusion is a condition. This is 
secured by manipulation of the muscles, by pressure 
over the deep nerves, and by tracing the superficial 
veins, giving particular attention to the saphenous 
opening. 



CHAPTER X. 



GYNECOLOGY AND OBSTETRICS. 

OUR race is entitled to a healthier motherhood. 
In eliminating drugs and substituting a rational 
method of treatment, Osteopathy has contributed much 
to this end. In pelvic, even more prominently than in 
other diseases, is the rationale of osteopathic treatment 
brought into view. 

Take off the pressure. Remove the stasis. Replace acause. emia 
and strengthen the organs. Nature will restore health 
and vitality if she have the opportunity. No matter 
what condition the disease of the pelvic organs may 
have assumed, there is too much blood there, for con- 
tinued over-stimulation of the vaso-constrictors would 
soon result in a weakness of both nerves and vascular 
walls and a consequent engorgement. Always too 
much blood, — hyperaemia. This results in a stasis, 
but still too much blood. Moving blood is health. 
Stasis reduces the nutritive properties of the blood, 
creases its percentage of waste products, deteriorates 



180 
the vascular walls and produces transudation and 
oedema. 

This increase of local fluid is an irritant to the nerve 
endings and the organs are excited to a condition of 
pain. This condition now results in a morbid metab- 
olism, either constructive as growths, enlargements, 
and tumors ; or to breaking down of tissue through 
retrograde metabolism, as in ulcerations. 

In almost all cases of pelvic disturbances leucorrhcea 
is a preceding condition, an unmistakable sign of 
hypersemia, venous stasis, and decreased vitality of 
vascular walls. This fluid should be returned by 
nature's conduits, the veins, designed to carry back 
the products of oxidation iu the tissues. If there be 
pressure on the venous channels anywhere between 
pelvis and heart then will this exudation be present. 
But this pressure to the veins is not the only factor 
which may disturb the vitality of the pelvic organs. 
Closely related as they are with the sympathetic ner- 
vous system and with the cerebro-spinal both directly 
and indirectly, the pelvic organs are the servants of the 
nervous system. Any change in their positions may 
irritate an afferent nerve and reflexly interfere with 
their nutrition and function. 

But this is not all. Any change that may occur 
along the pathway of these nerves will produce the 



181 

same effect. The pelvic organs are innervated by the Innervation 

of the pelvic 

nerves making their exit from the lumbar and from organs. 
the sacral portions of the spinal canal, and from the 
hypogastric plexus lying over the body of the fifth 
lumbar vertebra. 

The nerves to the ovary come from the uterus along 
the Fallopian tubes while another pathway is from the 
ovarian plexus, derived from the aortic plexus, thus 
related to the lower portion of the solar plexus. The 
hypogastric plexus also receives fibres from the 
lower dorsal thus connecting these organs with the 
lower dorsal and upper lumbar spinal segments. 

The arterial supply to the pelvic viscera is from the 
aorta via the ovarian and from the internal iliac via 
the uterine, drainage being effected into corresponding 
veins. 

In position the uterus extends from fundus a little 
below the brim of the pelvis, slightly to the right of 
the middle line to the upper portion of the vagina into 
which the cervix projects, meeting it normally at a 
right angle or greater. The condition of the bladder 
and rectum will affect the position of this organ. 

The Fallopian tubes extend from the highest point 
of the uterus laterally, lying below the level of the sacral 
promontory, enwrapped in the broad ligament. They 
are from three to five inches in length lying over and 



182 
around the ovaries. The latter bodies are about one 
and one-half inches long, one inch broad and one-half 
inch thick, and lie in the broad ligament. They lie 
just within the true pelvis at the side of the uterus and 
cannot normally be palpated through the abdominal 
wall. Their blood supply is derived from the ovarian 
artery, their nerves from the hypogastric plexus. 
Examination. Examination of the pelvic organs can be made in 
many cases and cures be affected without a vaginal ex- 
amination. This is often true in cases of young girls. 
The examination should first be directed to the spine 
in the following regions : the ninth to eleventh dorsal, 
the first to third lumbar, the lumbo-sacral articulation, 
the sacro-iliac synchondroses and the second and third 
sacral nerves. 

In addition, the fifth lumbar is almost invariably 
affected, either primarily disturbing the hypogastric 
plexus or reflexly from it. 

For a local examination the patient should be on her 
back, the legs flexed. The body of the patient should 
be covered. For examination the hand should be 
carefully cleaned and rendered aseptic, and slightly 
coated with some non-irritating substance. Should it 
become necessary to examine a virgin the greatest care 
must be taken to avoid rupturing the hymen. Often 
an imperforate hymen may be the cause of trouble. 



183 
The left hand should be used to depress the uterus 
through the anterior abdominal wall. Carefully notice 
the position of the uterus. In ordinary cases the in- 
dex finger should, without force, reach the uterus as it 
extends into the vagina. Should it be too close to the 
vaginal entrance there is prolapse. The direction of 
the os and cervix will determine whether the uterus is 
tipped anteriorly, posteriorly or laterally ; called ante- 
version, retro- version and latero- version. 

Should the fundus be bent upon the cervix the cor- 
responding flexion prevails. An examination with 
speculum and sound is often necessary. 

Should any of these conditions be present it is an 
indication of the presence of too much blood of an in- 
ferior quality. Pain and irritation have called too much 
blood to the parts ; stasis has caused its quality to 
deteriorate. I,ocal applications are useless. Pessa- 
ries and supports are in no sense correctives. The 
treatment consists in correcting the disturbances in 
some of the following locations : The muscles, liga- 
ments and vertebrae in the lower dorsal and lumbar 
regions should be made normal. An inpacted sigmoid 
and rectum may cause trouble to the uterus itself or to 
the hypogastric plexus. Overcome constipation and 
in many cases the cure is effected. Remove the pres- 
sure of the abdominal viscera, prevent lacing, cause 



Treatment. 



184 
patient to stand and sit with spine straight, thorax for- 
ward and abdomen drawn backward. Control of the 
lower portion of the abdominal parieties so as to exert 
a constant lifting force on the abdominal contents will 
prevent many diseases and overcome the incipient 
stages of all. 

The pudic nerve should be stimulated as it passes 
over the spine of the ischium. This nerve supplies 
most of the perineal muscles. By maintaining their 
tonic condition the vaginal walls are suported, thus 
keeping the uterus in place. Relaxation of the perin- 
eum tends toward prolapsus. 

Good effects are secured by drawing upward the pelvic 
portion of the abdominal wall. This is done while the 
patient is lying on her back, the legs flexed; or by draw- 
ing the viscera forward, the patient occupying the 
genu-pectoral position. Ordinary cases of displace- 
ments may be cured by the preceding movements. A 
very efficient treatment for misplacement is to insert 
two fingers into the vagina, the patient in the genu- 
pectoral position, the abdominal viscera pushed for- 
ward, then spread the fingers so as to admit air to the 
vagina. The pressure of the atmosphere will usually 
replace the uterus. The patient should remain quiet 
for some time after the treatment. Stimulation of the 



185 
round ligament is useful should there be retro-flexion 
or retro- version. 

Coccygodinea should be treated by removing any 
irritation to the coccygeal nerve ; and by quieting the 
coccygeal gland. A dislocated coccyx may give much 
trouble of this nature. 

Metritis is treated through the lumbar nerves and 
the hypogastric plexus. The pudic nerve is always to 
be treated in cases involving the vaginal walls. 

Ovaritis is often relieved at the lower dorsal or first 
lumbar through correction of osseous dislocation. 
Dysmenorrhcea can be relieved and cured by correc- 
tion of these lumbar and lower dorsal vertebra, and 
the sacro-iliac synchondrosis, together with the cor- 
rection of any uterine displacement. Amenorrhcea is 
relieved by building up the respiratory, circulatory 
and alimentary systems ; by spreading the lumbar 
vertebrae with a "figure of eight" motion; and in 
addition by striking your left hand, laid across the 
patient's sacrum, sharply with your right closed fist. 
This is a powerful stimulant. 

The foetus is formed as the result of the union of Development 

of embryo. 

matured male and female reproductive cells, either 
within the uterus or the Fallopian tubes. Segmenta- 
tion rapidly takes place, forming the blastoderm. A 
triple layered arrangement of cells prevails for two 



186 
weeks, at which time the stage of the ovum is suc- 
ceeded by the stage of the embryo, lasting until the 
fifth week. The remaining weeks of pregnancy are 
called the foetal stage. The formation of the neural 
folds and the notochord begins at the end of the 
second week. Up to this time the ovum has absorbed 
its nourishment from the lymph of the uterine mucous 
membrane. Now the development of the membrane 
begins. First the amnion, the innermost layer, is 
formed from the ectoderm and from, the mesodermal 
layer of the embryo. Outside of the true amnion the 
false amnion is formed by the reduplicature and fusion 
of the laminae of the true amnion. The allantois 
develops from the hind gut and serves to connect the 
foetus with the placenta. 

By its development the allantoic tissue unites with 
the outer or false amnion, serving to form the embry- 
onal portion of the placenta, uniting with the uterine 
or maternal portion which is developed from tissue of 
the mucous membrane of the uterus. There is thus a 
piacentd. double origin for the placenta. The sac of the allan- 

tois with its amniotic wrapping is the forerunner of 
the umbilical cord which connects the foetus and the 
mother through the placenta. The placenta receives 
blood from the uterine arteries of the mother which 
have been increasing from earliest pregnancy. It is 



Origin of 



187 
drained back to the maternal circulation by the uterine 
veins. The umbilical veins, later veins, begin in the 
foetal portion of the placenta and absorb through their 
capillary walls the pure blood brought thither by the 
uterine arteries ; the blood thus passes to the foetus, 
entering its venous circulation, the portal vein and the 
inferior vena cava. The placenta receives impure 
blood from the hypogastric arteries, constituent parts 
of the umbilical cord. 

Thus the nourishment for and the excrement from 
the foetus must be carried through the maternal 
vessels. 

The foetus during the first three months is largely 
head, assuming the human form during the ninth to 
the eleventh week. At five months the heart, liver 
and head are alike very much developed, while move- 
ments are now felt. The vernix caseosa is formed by 
the sixth month and is completed by the eighth. 

It is safe to assume that a woman apparent^ well 
formed will come safely through childbirth, so it is not 
necessary to examine the pelvis unless there is a 
deformity or a rachitic history. But there are certain 
precautions which every woman should take during 
pregnancy. Diet, of fruits and cereals, outdoor exer- 
cise and baths are conducive to an easy delivery and a 
perfect child. 



188 
When called the physician should carry with him a 
cool head and willing hands. In addition he should 
have a case containing tablets of mercury bichloride, 
shears, surgeons' cotton, a roll of clean muslin, a 
sponge and a spool of silk thread. 
Essential Uncleanliness and untidiness in a case of this kind 

Preparations. 

is a crime. The expectant mother should first be given 
a sitz bath carefully cleansing the perinseum. Then 
the hand of the operator after a thorough scrubbing 
with soap and water should be held in a bichloride 
solution, i to 1,000, for a few minutes and then an 
examination of the patient should be made. The 
hand should be thoroughly cleansed and rendered 
aseptic previous to each examination. This must 
never be disregarded. 

The bed should be prepared by placing either oil- 
cloth, rubber or a layer of newspapers beneath the 
sheet. The perinaeum and vagina should be thor- 
oughly relaxed. Pressure upon and manipulations of 
the perineal body will produce a ver}*- satisfactory 
result. The dilatation of the os may be very much 
hastened by passing the finger, thoroughly aseptic, 
around the edge of the os, also by pressure on clitoris 
and on round ligaments. This will lessen pain. 
To reduce the pain press on either side of the spine in 
the lumbar region, fourth and fifth, and in the eighth 



189 

to tenth dorsal ; this does not retard the progress Manipulations 

that aid in 

of the case. Should the pains and the expulsive c/nid-Mrtft. 
movements of the uterus become tardy, stimulation in 
the lumbar region may be very effective. Relaxation 
of the round ligaments as they pass over the pubic 
crest will allow the uterus to protrude further into the 
canal of the vagina. Steady pressure at the sym- 
physis pubis will also aid in relaxation of the parts and 
reduction of pain. 

Should the child be large and the labor difficult it is 
well to guard the perinseum by holding the hand 
against the perineal body, thus guiding the infant 
through the vaginal opening. Push the tissues from 
the symphsis toward the perineal body. 

As soon as the head is born examine to see if the 
cord be around the neck. If so, loosen and follow it 
with the fingers, one on either side, within the vagina 
to protect it from occlusion. In foot presentation the 
body should be wrapped in cloth or cotton to pro- 
tect from the air until the head is born. The cool air 
against the skin may stimulate the respiratory center, 
causing the child to breathe. 

As soon as the child is born, open its mouth, cleanse 
the mucous passages until it has given a good cry, 
then keep it covered and wait until the pulsations have 
ceased in the unbilieal cord. Now draw the cord 



190 
between the thumb and finger toward the unbilicus 
and tie with a clean thread about two and one-half 
inches from the infant's navel, tie again an inch 
further out and snip the cord between these points. 
If the placenta has not yet been delivered, gentle 
traction on the cord may produce it. The mother can 
usually assist by an expulsive movement, as cough- 
ing or blowing into the closed hand. There is 
no need to hurry in this matter, an hour may some- 
times elapse before the placenta is passed. In case it 
is not easily secured pressure on the abdominal wall 
above the pelvis may secure it. Place the palms flat 
How to obtain upon the walls and press forcibly downward. Do not 

the placenta. 

insert the hand into the uterus unless necessary. If 
the hand is inserted, be sure that it is aseptic. Pass 
the fingers between the placenta and the uterine wall, 
the air entering will often release it. If this is not 
sufficient, gently force it from the wall of the uterus. 
After the delivery, if there has been no laceration 
and no cause to suspect infection, the external genitals 
should be carefully cleansed, the vulva protected by a 
cloth fastened as the napkins are usually fastened. 
Between the napkin and the vulva should be a pad of 
surgeon's cotton. Should there be post-partum hem- 
orrhage it can be checked by stroking sharply, with 
cold hand, the mons veneris. 



191 

The uterus must be reduced to contract the vessels Antiseptic 

injeotions 

and close the sinuses. This is done by gently work- 
ing the fundus through the abdominal wall. This 
will reduce the intensity and the number of the after- 
pains and shorten the lying-in period and prevent 
hemorrhage. 

The mother should, after being made scrupulously 
clean, be left to sleep. Rest is the great restorer. The 
nurse should be instructed to carefully cleanse the ex- 
ternal genitals with soap and water, following with a 
solution of bichloride of mercury, i to 2,000. Should 
it be deemed necessary to use an injection a perfectly 
sterile pipe must be used, having been dipped in boil- 
ing water, both tube and pipe having been left in a 
bichloride solution of 1 to 1,000 for ten minutes. The 
injection may be 1 to 4000 bichloride or creolin 1 to 100 

The nurse should be given explicit directions as to care of me 

r hreasts. 

the care of the patient, The breasts should be watched 
carefully. A scanty secretion of milk may be in- 
creased by a separation of the upper five or six ribs, 
lifting scapula, and freeing the subclavian and axillary 
arteries. This affects the internal mammary branches 
which supply the mammary gland. It also stimu- 
lates the intercostal nerves in this region. We spread 
the ribs increasing the blood supply through the 



192 
perforating arteries, and giving a perfect drainage 
through the veins. The internal mammary artery may 
be reached at its origin from the subclavian, producing 
effect through the plexus derived from the subclavian 
and from the inferior cervical ganglion, Let me repeat 
that the introduction of the hand into the uterus to 
take the placenta is the most dangerous part of child- 
birth. It should be done only as a last resort. 



CHAPTER XL 



CONSTIPATION, RHEUMATISM AND CATARRH. 

/^\CCUPATI0N, diet, the drug habit, irregularity 
^-^ in the time of defecation, morbid secretions of 
liver and pancreas, osseous lesions and general neurotic 
conditions, are causes of constipation, while this may 
in turn be the cause of anaemia, neuritis, menstrual 
disorders, poor circulation, piles, haemorrhoids, etc. 
The normal time for evacuation is once per day though 
it may vary from this, twice a day being perfectly 
natural with some and once every second day being 
in many cases normal. 

The condition is massing of fecal material in the 
lower bowel, — usually the descending colon and the sig- 
moid. A preceding atony of the colon, particularly the 
musculature of the sigmoid, is frequently an obstinate 
cause. That constipation so frequently follows peri- 
tonitis and fevers is a suggestion of a very common 
cause, viz. : inflammation with its consequent engorge- 
ment and stasis. 



194 



Cause and 
effect of im- 
paction. 



Innervation 
of intestines. 



The presence of fecal matter within the intestine 
should lead to a normal peristalsis, — when the nerves 
are no longer stimulated by such a condition, or when 
the muscles fail to respond to such stimulation, then 
costiveness results. If normal peristalsis occurs above 
while there is sluggishness in the lower portion of the 
tract, then impaction must occur. This impaction 
may occur at the hepatic or splenic flexures, or in the 
left inguinal region, extending down into the sigmoid 
and the rectum. In case of such impaction the 
masses must be broken up and removed before the 
treatment directed toward restoring tonus to the mus- 
culature and health to the mucosa can be effective. 

The blood supply is from the superior and inferior 
mesenteric arteries to the colon and sigmoid, while the 
rectum receives its supply from the inferior mesenteric, 
the internal pudic, the sacra media, the sciatic, and, 
in the female, the vaginal. 

The innervation of the lower bowel is from the 
vagus, lumbar and sacral, — the vagus supply- 
ing the alimentary tract as far as the sigmoid 
while the lumbar and sacral are inhibitor and aug- 
mentor respectively to the remainder. The lumbar 
are, in addition, vaso-constrictors through their rami 
communicantes, while their secretory fibres must con- 
trol the flow of the intestinal juices. The- sacral 



195 
nerves distributed directly to the pelvic organs are the 
vaso- dilator and also viscero-motor to the large intes- 
tine. The lower portion of the rectum receives fibres 
from the inferior haemorrhoidal, a branch of the pudic. 

In treatment of this condition the patient must yield 
strict obedience to directions. Few things are better 
than outdoor exercise. 

The normal number of nerve impulses should be 
sent along the nerves of the abdominal muscles, the 
muscles of the thigh and the hip in order that the 
proper amount of impulses reach the lower portion of 
the intestinal tract, which is innervated by nerves 
originating in the corresponding segments of the 
cerebro-spinal axis. Physiological nerve impulses 
passing along the lumbar and sacral nerve trunks, 
both afferent and efferent, cannot but favorably affect 
the splanchnic fibres from the same nerves distributed 
to the viscera within the abdominal and pelvic cavities. 
Any form of physical exercise involving the use of 
the muscles of the abdomen and thigh will thus be 
beneficial to this particular condition. 

See that your patient uses water freely ; few people 
drink enough. The lower bowel is the great dessi- 

Water < f 

cator ; but, should the fecal mass contain but little value ' 
fluid this will all be taken, and a dry and hard resist- 
ant mass will remain to irritate the intestinal mucosa 



196 
until finally it fails to respond to such irritation. 
Then sets in an atonic condition of the bowel, due to 
its over-distention by the continual crowding down 
from above the material left from each meal. Three 
pints of water per day is necessary, and more than 
this amount if much is taken from the system by per- 
spiration. This water is a stimulus to the circulation 
and to the liver, and an incalculable benefit to the 
kidneys. 

The osteopathic treatment for constipation is based 
upon the anatomy and physiology of the bowel and 
its contributory glands. The liver, by its contribution 
of bile, is one of the most important organs in the 
work of the bowel. Its bile is beyond doubt the 
normal stimulus to peristalsis. Thorough change of 
blood within the substance will overcome the stasis of 
blood and reduce the resistance "afronte," thus 
facilitating the drainage from the entire alimentary 
canal from stomach to rectum. This reduction of 
stasis will of itself overcome plethora of venous blood 
within the mesentery, meso-colon, meso-sigmoid and 
meso-rectum. 

Venosity of blood is itself a cause of excessive peri- 
stalsis, should the venosity be introduced suddenly, 
but when it comes gradually as the result of a 
decreasing activity of the liver then it leads to atony 



197 

of the walls, sluggishness, impaction and the various 
attendant conditions of constipation. Hence to relieve 
constipation, stimulate the liver to activity by treating 
directly over the walls of the abdomen and thorax 
beneath which it lies. A stimulation along the line 
of the hepatic artery, pressure against the gall cyst, the 
patient making the greatest expiratory effort with the 
thighs flexed upon the abdomen, will be effective. Sep- 
aration of the ribs by the aid of the serratus magnus 
and latissimus dorsi, and correction of any osseous 
lesion that may exist near the ninth or tenth dorsal 
will restore the liver to normal function. 

In addition to this treatment of the liver the bowel 
must have especial attention. The major portion of 
the large intestine and all of the small intestine receive 
their secretory, trophic, vaso-motor, motor and inhib- 
itory nerves via the solar plexus. Through their end- 
ings these fibres may be reached at any part of the 
abdominal parieties anteriorly or in the splanchnic 
region of the spine. 

The colon, sigmoid and rectum must first be 
cleansed from any impacted feces. The colon should 
be carefully kneaded. By such action the end fibres 
of the pneumogastric nerve may be stimulated, thus 
increasing peristalsis. The secretory fibres in the 



Treatment. 



198 
plexus of Meissner are also stimulated, thus tending 
to restore the normal condition. 
Lesions in The lumbar region will usually show lesions in con- 

constipation. ° 

stipation. These may be osseous, and if such will be 
corrected, each case demanding its own treatment. In 
case of muscular contracture which has cut off the 
nerve force to the part, then such contracture must be 
reduced. This will usually be found to be in the 
region of the quadratus lumborum. This muscle may 
be stretched by a bias stretch, placing one hand on the 
iliac crest, the other on the lower ribs at or near their 
angles, the patient lying on his side with face toward 
the operator. Drawing the ribs toward him and the 
ilium from him, and then reversing the movement the 
operator is enabled to accomplish a thorough reduction 
of this muscle. The psoas muscles lying in contact 
with the ascending and descending colon and also 
containing, as it were, the origin of the lumbar plexus, 
is an important factor in osteopathic manipulation for 
constipation. It is attached to the lumbar and to the 
last dorsal vertebrae, and is inserted into the lesser 
trochanter. Flexion, rotation and circumduction of 
the thigh will affect this muscle which will in turn in- 
fluence the lumbar plexus. Good results are obtained 
by placing patient on face and strongly raising 
the legs. 



199 

The sacral nerves are the motor nerves to the 
descending colon, the sigmoid and the rectum, and 
their stimulation will increase the movement of that 
portion of the canal. 

There is often soreness in this region, showing Thepudic 

° nerve. 

need of stimulation to these nerves. The pudic 
nerve which sends its inferior haemorrhoidal branch to 
the rectum may be reached at the ischio-rectal fossa. 
This nerve should not be overlooked in constipation as 
it often has an important effect on this condition when 
due to rectal enervation. 

The sphincters should also be carefully examined as 
it may be that they are so contracted as to prevent the 
passage of the feces. The finger well covered with 
vaseline is a good dilator. After the insertion of one, 
two should be inserted and then forceful separation 
serves to overcome the contraction of the sphincter. 
The finger should carefully examine the rectal walls 
for prolapsus, growths or haemorrhoids. 

The coccyx should be examined, as it is often 
thrown forward, acting as a physical impediment. It 
can be replaced by passing the finger above and in 
front of it and drawing downward, thus extending it 
upon the sacrum. The ganglion impar, situated on 
the anterior surface of the coccyx, is easily reached 
per rectum and its stimulation serves to increase the 



200 
activity of the sympathetic nerves regulating the cir- 
culation and the alimentary systems. 

The sigmoid is often more or less prolapsed in case 
of constipation. This can be raised by traction in the 
iliac region through the abdominal wall, the patient 
lying on side, the operator standing behind, the legs 
being slightly flexed in order to loosen the abdominal 
wall. Should the vertebrae be posterior the patient 
may lie on side and the operator first exaggerate the 
condition by curving the lumbar spine, then pressing 
upon the prominent spines while returning the spine 
to the normal condition. The patient may lie face 
downward, after thorough and complete relaxation, 
and the operator put sudden pressure upon the spines. 
This is very effective, though care must be used to 
avoid violence. 

The patient seated on a stool is in a position of 
advantage. Sometimes it is helpful to have the 
patient lie obliquely across the table and then put an 
auger twist upon his legs. In addition to these treat- 
ments the quadratus lumborum must be relaxed and 
the thighs flexed and rotated outward so as to call 
into activity the psoas muscle. Separation of the 
knees against the muscular resistance of the patient is 
of value. 



201 
RHEUMATISM. 

The term rheumatism does not carry with it any symptoms. 
definite idea of either cause or symptoms. Manifest- 
ing itself by pain, with or without swelling, it inter- 
feres with the use of the muscles, enlarges the bones 
at their articular portions, and by stasis of blood 
stiffens the ligaments, tendons and connective tissue 
until from proliferations and shortening of the fibres 
motion is more or less completely lost. This may 
affect one articulation or may involve the entire body. 
The presence of lactic acid or its isomeric form in the 
blood in this disease has led to the belief that it is one 
of the primary causes of the disease. Though often 
present it does not follow that lactic acid is a cause of 
the disease, but would rather suggest it as a result. 
The fact that the disease may confine itself to one or 
to a few articulations would indicate that there are 
other factors involved. Our system of therapy 
teaches that every organ or member will function 
properly if its structure be perfect and the natural 
nerve impulses be unchanged. 

That a single tissue or organ may be the seat 
of rheumatic affection points unmistakably to a weak- 
ened power of resistance on the part of that tissue or 
organ, or else to what is the same thing, deficiency in 
nourishment or to a failure in impulses reaching it 



Etiology. 



202 
from the nervous system. That there are disturbing 
elements in the blood cannot be doubted. That they 
are the result of failure of the assimilative tissues, 
increased by a disturbance of the harmony existing 
between katabolism and excretion, seems certain. 
This, then, will attribute the trouble to the liver on 
one hand and to the kidneys on the other. The respir- 
atory power may be at fault, leading to retarded 
oxidation and to the formation of suboxides. The 
change in the functioning of the liver interferes with 
the character of the blood, thus involving the heart 
and interfering with the circulation. 

Our treatment is directed to the nervous system to 
re-establish the proper control of the disturbed organs. 

In all cases the diet must be carefully selected ; 
cereals, little meat and a reduction of the carbo- 
hydrates will aid in overcoming the acidity of the 
blood and in resting a disturbed digestive tract. 

As an adjunct to other treatment the patient should 
be required to drink freely of hot water. This serves 
to flush the sewers of the body, thoroughly cleansing 
the capillaries and washing the detritus from the tub- 
ules of the kidneys. 

In case of muscular rheumatism affecting one 
muscle or a group of muscles, look for a lesion at 
the exit of the nerve which supplies that region. 



203 
Pressure upon the nerve, either at its emergence or 
along its course may be the cause of the condition. 
This frequently disappears after a single treatment. 
Remove the cause and torticollis, lumbago and similar 
forms disappear. 

The mono-articular type, whether chronic or acute, 
is in most cases a result of a local injury. Correction 
of this lesion will be followed by cure. 

In cases affecting the lower limbs the three points 
to be noticed most carefully are the tissues around the 
exit of the sciatic nerve, the saphenous opening and 
the lumbar spine. In case the upper limb is affected 
the points to be most carefully scrutinized are the 
cervical vertebrae from the fifth to the eighth, the 
interscapular area and from the second to the sixth 
dorsal and the brachial plexus. 

In all cases the spine must be corrected, stretched 
and relaxed. All lesions in the region of the liver, Treatment 
seventh to tenth dorsal, must be corrected. These 
may be lesions of bone or of muscle. 

The kidney region, eleventh dorsal to first lumbar, 
must have the same care in order that the excretion 
may be thoroughly accomplished The entire splanch- 
nic area must be stimulated to activity. The various 
nerves affected must be freed from pressure their entire 
length so as to overcome stasis in their blood supply. 



204 
In case the hands and feet are affected treatment 
must be given each articulation to maintain and secure 
mobility. While the nerves are hypersensitive, caus- 
ing a chronic shortening of the flexor muscles, it is of 
value to thoroughly knead the muscles to secure their 
relaxation. Stretching the muscles will prevent such 
contracture or will correct it if present. In case of 
oedema the effusion can be removed by pressure and 
movement directed toward the venous flow. Acute 
attacks should be treated two or three times each day. 
Hot baths are valuable adjuncts to the treatments, 
though care must be used to avoid taking cold. 

CATARRH. 

In considering the various forms which this disease 
may assume it is well to consider the primary changes 
in the mucous membrane with which it is associated. 
There is always an initial dilatation of the blood ves- 
sels due to an inhibition of the local vaso-constrictor 
action. This results in an increase of capillar}' pres- 
sure, venous stasis, transudation of lymph, oedema and 
discharge. This discharge at first is thin and watery 
but soon changes to greater consistency. 

It may be acute (coryza), chronic (rhinitis), seasonal 
(hay fever). This catarrhal condition may affect the 
mucous tract anywhere. Our treatment for it is as 



205 
follows : Secure a thorough drainage of the catarrhal 
tract by removing any stoppage to the veins from the 
part. Begin this by thorough relaxation of the fol- 
lowing muscles of the neck : the platj^sma, sterno- 
cleido-mastoid and the more deeply lying infrahyoid 
group, the scaleni, the recti capiti and the longus colli. 
This treatment should now be followed by a thorough 
relaxation of the muscles in the upper dorsal region 
including the muscles connecting trunk, neck and 
occiput. 

A thorough stimulation of the superior cervical Treatment of 

catarrh. 

ganglion will reduce the venous stasis while a stimu- 
lation of the cardiac center in the upper dorsal region 
will result in sending blood from the mesenteric reser- 
voir of capillaries to the cutaneous surfaces, relieving 
the mucous congestion, equalizing the general pressure 
and at the same time furnishing the congested mem- 
brane with a fresh supply of pure blood. 

The nutritive fibres to the muscles of the face are 
transmitted by the seventh nerve. This may be 
treated by relaxing the tissues around its exit as it 
traverses the space between the stylo-mastoid foramen 
and the ramus of the inferior maxilla. 

The sensory and trophic distribution to skin of 
the face and mucous membrane of catarrhal tract 
is through the fifth, ninth and tenth nerves. These 



206 
nerves are treated as follows : Pressure on the 
fifth nerve at its points of emergence on the face will 
quiet the sensory nerves and bring blood to the sur- 
face. Downward pressure over the carotid sheath will 
reach the tenth nerve and at the same time assist in 
drainage. The ninth nerve is reached as it leaves the 
jugular foramen, also on the tonsils internally, in case 
it affects the Eustachian tube or the middle ear. 

The first, second and third cervical are often at fault 
in this trouble. 



CHAPTER XII 



HOW AND WHERE. 

( A few practical hints for emergencies. ) 

IN case of eye trouble, inflammation, pain, «tc, not 
due to the presence of a foreign body, treat the fifth 
nerve at its terminal portions around the orbit ; the 
superior cervical ganglion, which through the carotid 
and cavernous plexuses is distributed to the eye and to 
the parts surrounding it ; the first and second cervical 
vertebra ; the upper dorsal, the latter being the exit of 
the fibres going to the eye. Pressure on eye for 
muscles of orbit and for ciliary ganglion on fifth nerve. 
Ear : The ninth nerve for the ramus tympanicus ; 
the auricular branch of the tenth ; the auriculo-tem- 
poral from the inferior maxillary of fifth ; the small 
occipital and the great occipital ; the ninth for deaf- 
ness and ringing in the ear; the cervical and the auric- 
ulotemporal for earache. Relax the opening of the 



208 
Eustachian tube in pharynx ; the second cervical 
vertebra is often a disturbing factor. 

Thyroid Gland : Over gland itself, following veins, 
at middle and inferior cervical ganglia, raise the clav- 
icle ; correct first rib. Fifth and sixth cervical ver- 
tebra. 

Bronchial Tubes : The upper three ribs ; relax the 
intercostal muscles ; relax the muscles in the corre- 
sponding spinal segment ; raise the ribs. 

Lungs : Treatment much the same as for bronchial 
tubes, extending lower to ninth. 

Heart : Quiet it by steady pressure at annulus of 
Vieussens. Raise fifth rib ; separate ribs on left side ; 
hold vaso-motors; correct lesion in upper dorsal region; 
inhibit solar plexus to equalize circulation. 

Larynx : Tenth nerve ; superior cervical ganglion. 

Tonsils : Treat by stimulating superior cervical 
ganglion ; by working over their mucous covering ; 
by treatment at exit of ninth and tenth nerves. 

Headache : Work downward over carotid sheath to 
aid in drainage ; to check blood supply bend back head, 
pressing tightly against vertebral artery ; steady pres- 
sure on great, small and suboccipital nerves at basi- 
occiput ; steady pressure on filaments of fifth nerve ; 
look for uterine or ovarian trouble : stomach fre- 



209 
queutly at fault ; press on solar plexus. In anaemic 
headache stimulate heart action. 

Liver : Relax at ninth and tenth; vibrate the liver; 
treat over solar plexus ; reach gall cyst under ninth 
costal cartilages on right side ; knead liver. 

Stomach : Pressure at third and fourth dorsal on 
right side ; osseous lesions, third to fifth ; quiet vom- 
iting, pressure at angle of third to fifth ribs on right ; 
elevate the ribs. 

Small intestine : Reach mesentery through naso- 
gastric zone ; solar plexus back of stomach ; in middle 
and lower dorsal. 

Large intestine : Flux and diarrhoea ; patient on 
face ; strong pressure on each side of spines in lumbar 
region ; lift legs while pressing, springing spine for- 
ward. 

Enuresis : Look for trouble in middle lumbar ; 
sometimes lower ; examine clitoris in female, glans in 
male for irritation ; examine urine for cystitis ; correct 
spinal lesion ; examine for phimosis, vulvitis, worms. 

Croup : Loosen the tissues of the neck, giving 
especial attention to the deep muscles ; work on supe- 
rior cervical ganglion ; follow veins and lymphatics 
for drainage. Stimulate in dorsal region. 

Sciatica : Lesion is usually in lower lumbar ; often 
a contraction of pyriformis causes it ; stretch this and 



210 
other external rotators by turning thigh inward, press- 
ing on structures closing the greater sacro-sciatic 
notch ; follow nerve to knee, relaxing the structures ; 
flex leg on thigh and thigh on pelvis, then with thigh 
flexed extend the leg. This will effectually stretch 
the sciatic nerve. 

Toothache : Press on branches of the fifth nerve, 
either at infraorbital or just below malar bone, over 
spheno palatine ganglion beneath the zygoma, and 
near the articulation of inferior maxillary. 

Fainting : I^eave head low ; stimulate heart to 
action through the inferior and middle cervical gan- 
glion. In case of prolonged unconsciousness the 
fingers inserted into the rectum, briskly stimulating 
the ganglion impar, will usually be effective. Stim- 
ulate the suboccipital region. 

Anterior upper dorsal : Cross patient's arms in 
front, stand behind. Pull on wrists and push outward 
and forward on scapulae. An assistant is necessary 
for this work. 

Epistaxis : To stop bleeding stimulate superior cer- 
vical ganglion. Press on nose at inner canthus of eye. 

Rigors : Strong stimulation in dorsal region. Stim- 
ulation of inferior cervical ganglion. Strongly stimu- 
late liver. Stimulate solar plexus. Increase respira- 
tory activity. I^oosen contractures in cervical region. 



211 

Epileptic convulsions : Hold strongly on suboccip- 
ital region, pressing head backward. Relax the 
muscles in upper dorsal. 

Cramps and clonic spasms in women attributable to 
uterine irritation : Inhibition in lumbar region and the 
round ligaments ; sometimes replace uterus. 

Hiccoughs : Inhibition of the phrenic over the 
third, fourth and fifth cervical. If severe, treat 
splanchnic area. 

Tormina : Inhibit lumbar nerves and solax plexus. 

Tenesmus : Inhibit over sacrum. 

Depressed rib : Use arm as lever and while pulling 
upward and backward with one hand, press strongly 
at angle of ribs with other, maintaining the pressure 
until the arm is returned to a position of rest. 

Patient may lie on side or back, or may sit for this 
treatment. The knee ma}' be placed against the 
vertebra, operator then using both hands. 

First or second rib elevated : Place thumb of one 
hand on head of rib. Draw hand in opposite direction 
so as to tighten scaleni muscles, then pressing down- 
ward on rib rotate the hand and draw back toward 
affected rib. This will slip rib into position. 

Eleventh and twelfth rib elevated : Stretch quadra- 
tus lumborum and push downward on angle of 
depressed rib. 



GENERAL INDEX. 



A 

Abdomen . . . 147 

Allochiria 49 

Amenorrhcea 185 

Ankle 177 

Tendons of 178 

Drainage of 178 

Antisepsis 32 

Aorta, bifurcation of 148 

Arm, vaso-motors of 94, 103 

Vasoconstrictors of 76 

A lever 127 

Arteries, coronary 80 

Carotid 122 

Internal mammary 192 

Subclavian 122 

Anterior tibial 177 

Posterior tibial 177 

Femoral 175 

Of intestine 194 

Articulation, lumbo-sacral. . . .161 

Claviculo-acromial 169 

Asepsis 32 

A safe guard 40 

Method of securing 191 

Atlas 98, 115 

Augmentors, cardiac 65, 73, 99 

Axis 98-116 



B 

Bacillus 33 

Bacteria, Classified 33 

Defined 33 

Where found 34 

Size of 34 

Developement of 34 

Products of 35 

Bladder, sensory nerves to.. .96, 104 

Blastoderm 185 

Blood, a germicide 32 

Brain, vaso-motors for 93 

Breasts, care of 191 

Treatment of 191 

Bronchial Tubes 208 

Treatment of 146, 208 

c 

Cecum ' 158 

Canal, inguinal 148 

Catarrh 204 

Symptoms of 205-206 

Lesions for 206 

Causes of Disease 21 

Cell, a unit 41 

Function of 41 

Conditions of development 41 



214 



Center, defined 56 

Osteopathic 56 

For coughing 56 

Eye, ear, face 98 

For hiccoughs 98, 211 

Lungs, arm, heart 99, 103 

Stomach 100, 103 

Liver 100, 103 

Spleen 100, 103 

Chilis 100 

Uterus, ovary 100 

Diarrhoea , 100 

Bladder , 101 

For vagina 101 

For spinchter ani 101, 104 

For pharynx 102 

For duodenum 103 

Vaso-motor 85 

Osteopathic 98 to 104 

Thermogenic 92 

How treated 57 

Chest, examination of 136 

Asymmetry of 137 

Enlargement of 138 

Lines of 143 

Clavicle 164, 166 

Depressed 128 

Cocci 33 

Coccyx 162 

In constipation 199 

coccygodynia ... . 185 

Contraction 59 

Contracture 112 

Collaterals 64 

Constipation, causes of. . 193 

Treatment of 196 

Lesions for 198 

Convulsions. 211 

Cord, umbilical 189 

Umbilical, cutting of 190 

Cramps 211 



Croup, treatment of 209 

Curves, spinal 114 



Diarrhoea 100, 209 

Diet 18 

Disease, defined 19 

Causes of 20 

Transmission of 23 

Disinfection 40 

Dislocation, femoral 148 

Duodenum 157 

Dysmenorrhcea 185 

E 

Ear, treatment of 207 

Nerves of 207 

Elbow, landmarks of 170 

Dislocation of. 171 

Enuresis 209 

Epistaxis 210 

Eustachian Tube 121 

Examination, position for.. 11 7, ir8 

Vaginal 182, 183 

Eye, lesions for 68 

Treatment of 207 



Fainting 210 

Fallopian Tubes 181, 182, 185 

Fascia 48 

Femoral Ring 148-173 

Femur, head of 173 

Condyles of 176 

Flux 209 

Fcetus, development of 185, 186 

G 

Gall Bladder 152 

Treatment of . 153 

Ganglion, Meckel's 120 



215 



Impar 62 

Superior cervical 67 

Middle cervical 7° 

Middle cervical, function of. .70, 71 

Middle cervical, fibres from 71 

Inferior cervical 71 

Superior cervical 87 

Genitalia 94, 104 

Germs 32 

Pathogenic 35 

How enter tissue 39 

Diseases 36 

Diseases, how treated 37 

Gland, thyroid 93, 99, 103, 125 

Thyroid, vessels of 125 

Thyroid, nerves of 125 

Thyroid, treatment of 125 

Gynecology 179 



Immunity, by heredity 23 

Defined 38 

Examples of 38 

Impulses, nervous 25 

Impaction 194 

Impar, ganglion of 199 

Inhibition, effect of 50 

Defined 53 

By reflex 108 

Inspection 137 

Intestine 94, 103, 209 

E 

Kidney... 94, 99, 1 59 

Sensory nerve to 96 

Treatment of 159 

Knee 175 

Ligaments of 176 

Structures around 176-177 



Hart, Dr., theory of 109 

Health 15 

How maintained 42 

Head's law 49, in 

Diagnosis by , 50 

Heart 94, 96 

Treatment of 80, 140, 141, 208 

Position of. .129 

Boundaries of 139 

Trouble, lesions for 142 

Centers for 96, 103 

Headache 208 

Heredity 23 

Hiccoughs 98, 211 

Hilton's law 48 

Hip 173 

Dislocation of 174 

Hyoid bone 121 

Hyperemia 26, 179 

Hyperesthesia 26 



Larynx. 
Leg 



121, 208 
94 



Lesions, structural 21 

Defined 24 

Kind of 24 

Effect of 24 

Osseous 25, 26 

Muscular . 26, 43 

Correction of 27 

Leucomain 35 

Leucorrhcea 180 

Ligament, Poupart's 149, 173 

Ligamentum Nuche 122 

Linea Alba 147 

Line, Nelaton's 174 

Liver 94, 96, 103, 209 

Treatment of 130, 149, 153 

Displacement of 150 

Percussion 150 



216 



Function of 150 

Nerves of , 151 

Center for 152 

Lungs, examination of . 143 

Location of 144 

Nerves of 146 

Sensory center 96, 146 

Treatment of 146, 208 

M 

Malleoli 177 

Meckel's Ganglion 69 

Mechano-Therapy 59 

Meissner, plexus of 198 

Mesentery 158 

Membrane, costo-coracoid 129 

Metritis 185 

Metabolism 45 

Micro-organisms 21, 34 

Misplacement, correction of ... 184 

Mouth 121 

Muscles of Neck 122 

Of shoulder 170 

Pyriformis 161 

Deltoid .168 

N 

Neck 121 

Muscles of 122 

Nerves 25 

Nerve Action, how influenced. . 52 

Activity, basic 56 

Depressor 88 

Seventh 120 

Fifth 120 

Circumflex 168 

Superscapular 168 

Pudic 184, 185, 199 

Sciatic 175, 203 

To rhomboid 169 

Median 170 



Ulnar . .. .170 

Obturator 175 

Nervi Erigentes 78, 83 

Nerves, sacral 83, 113, 199 

Of vagina 83 

Of uterus 83 

To bladder. 96, 104 

Laryngeal , 126 

Of intestine 194 

To pelvic organs 181 

Notch, sacro-sciatic . 161 

Nutrition 102 



Obstetrics 179 

Obstruction 45 

Olecranon 171 

Os, dilatation of 188 

Osteopathy Defined 51 

Osteopathy a Science 97 

Ovaritis . . 185 

Ovary, center for 100 

Sensory nerve to 96 

Oxidation 46 



Pain, a warning 42 

Sign of a lesion 43~47 

Superficial 47 

Palpation 139 

Parturition 188 

Patella 175 

Pelvis 160 

Pericardium 80 

Pilo-motor Nerves 65 

Placenta 186-190 

Pleura 80 

Plexus, cavernous 68, 69 

Cardiac 78, 79 

Hypogastric 82 

Prevertebral 62 



217 



Pelvic 82 

Prostatic 83 

Solar 8o, 155 

Pressure 48, 91 

Pregnancy 187 

Prophylaxis 19 

Prostate, nerves to. 96 

Ptomain 35 

R 

Radius, head of 171 

Rami Communicantes 63 

Illustration of 84 

Rami Efferentes 66, 88 

Rectum, center for 103 

Region, suprascapular 132 

Suprasternal 124 

Superior sternal 126 

Inferior sternal 126 

Supraclavicular 127 

Infraclavicular 128 

Inframammary 130 

Regions, lateral 131 

Axillary 131 

Infraaxillary 132 

Posterior 132 

Subscapular 132, 134 

Infrascapular 134 

Interscapular 135 

Resorption 60 

Rheumatism 201 to 203 

Ribes, ganglion of 62 

Ribs, setting 211 

Rigors 210 

Ring, external abdominal 148, 160 

s 

Saphenous Opening 173, 203 

Scalp 119 

Sciatica 209 

Shoulder 128, 164 



Landmarks of 165 

Space, popliteal 177 

Spine, pubic 148, 162 

Anterior superior iliac 148 

Lesions of 116 

Spine, examination of. 114 

Landmarks of. 117 

Ischiatic 161 

Posterior inferior 161 

Of ilium 173 

Leverage on 169 

Spinal Treatment ioj 

Spinous Processes 105 

Splanchnics 74, 75, 81 

Spleen 94, 154 

Stimulation . . .38, 48, 49, 52, 58, 112 
Stomach, sensory nerves to 

96, 154, 155 

Center 100, 103 

Treatment 209 

Location of 131 

Suboxides 20 

Susceptibility 39 

Sympathetic System 61-85 

Cervical 73, 99 

Lumbar 77 

Sacral 77 

Sacral, visceral branches of 78 

Thoracic 73, 74, 75 

Symphysis, pubic 163 



Tenesmus 211 

Testis 96 

Thorax 123 

Thyroid gland 208 

Tissues 41 

Tone 53, 55 

Tox-albumin 35 

Tonsils 208 

Toothache aio 



218 



Tormina 211 

Trachea 121 

Treatment for pelvic trouble. 183-184 

Triangle, Scarpa 174 

Trochanter Major 173 

Trunk 94 

Tuberosity Ischii 162 

u 

Umbilicus , 144 

Ureter, nerves to 83 

Sensory nerves to 96 

Uterus, nerves of 83 

Sensory nerves to 97 

Position of. 181 

Contraction of , 191 

Center for 100, 104 

v 

Vagina, nerves of 83 

Vagus Nerve 8i, 156 



Vas Deferens 83 

Vaso Constrictors 

49. 64, 87, 90, 91, 107 

Constrictors for head 73 

Motors 85, 88, 91, 92 

Motors center 85, 91, 92 

Motors center for head, throat, 

tonsils, nose, tongue, eye 92 

Vaso-dilators 86, 107 

Veins, innominate 122 

Short saphenous 177 

Jugular ... 121 

Vertebra, anterior 210 

Vieussens, annulus 72, 99 

VlSCERO-MOTOR 65, 108 

w 

Water 195-196 

Wrist 172 

Landmarks of. 172 

Tendons of 172 



